彩色多普勒对视网膜静脉阻塞血流动力学分析

目的 探讨视网膜静脉阻塞（ＲＶＯ）血流动力学改变。方法 经散瞳眼底检查及眼底荧光血管造影确诊为ＲＶＯ病例５２例,健康对照组５２例,使用Ａｃｕｓｏｎ １２８ＸＰ／ １０型彩色电脑声像仪,测定也视网膜中央动脉（ＣＲＡ）、中央静脉（ＣＲＶ）及眼动脉（ＯＡ）的收缩期最大血流速度（Ｖｍａｘ）、舒张期末最小血流速度（Ｖｍｉｎ）及阻力指数（ＲＩ）。结果 ＲＶＯ患者ＣＲＶ和Ｖｍａｘ及Ｖｍｉｎ均明显低于健眼（Ｐ〈０．     

视网膜中央静脉阻塞的彩色超声多普勒检查

采用彩色超声多普勒成象技术对１０例视网膜中央静脉阻塞患者进行视多膜中央动、静脉的血流测定，并选择１０例性别、年龄相当的正常健康人进行对照。结果显示：患眼的视网中央动脉收缩期峰值血流速度（ＰＳＶ）和加速度（Ａ），平均视网膜中央静脉以速（ＣＲＶ）较对侧健肯和正常对照明显降低，而且ＣＲＶ较ＰＳＶ降低明显，提示ＣＲＶ的测量可能在鉴别缺血型与非缺血型视网膜中央静脉阻塞以及预测新生血管并发症的产生方面有一定意     

彩色多普勒成像技术检测视网膜静脉阻塞眼血流动力学的变化

目的探讨视网膜静脉阻塞(retinal vein occlusion,RVO)患者视网膜中央动脉(central retinal artery,CRA)和视网膜中央静脉(central retinal vein,CRV)血流动力学特征及其意义。方法使用ATL-HDI3000彩色多普勒诊断仪，检测RVO患者患眼48只、对侧临床健康眼39只及正常对照眼40只的CRA收缩期峰值血流速度(peak systolic velocity,PSV)、舒张末期血流速度(end diastolic velocity,EDV)和血管搏动指数(pulsatility index,PI)，CRV最大血流速度(maximun velocity，Vmax)。结果RVO患眼、对侧临床健康眼CRA的PSV和EDV均显著低于正常对照眼，RVO患眼PI显著高于正常对照眼；RVO患眼CRA的PSV显著低于RVO对侧临床健康眼，RVO患眼PI显著高于RVO对侧临床健康眼；RVO患眼、对侧临床健康眼CRV的Vmax均显著低于正常对照眼。结论RVO患眼和对侧临床健康眼血流动力学异常。彩色多普勒成像技术可作为其早期诊断的重要手段。(中华眼底病杂志,1998,14:111-113)     

彩色多普勒成像技术检测视网膜静脉阻塞眼血流动力学的变化

目的探讨视网膜静脉阻塞（ｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＲＶＯ）患者视网膜中央动脉（ｃｅｎｔｒａｌｒｅｔｉ－ｎａｌａｒｔｅｒｙ，ＣＲＡ）和视网膜中央静脉（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎ，ＣＲＶ）血流动力学特征及其意义。方法使用ＡＴＬ－ＨＤＩ３０００彩色多普勒诊断仪，检测ＲＶＯ患者患眼４８只、对侧临床健康眼３９只及正常对照眼４０只的ＣＲＡ收缩期峰值血流速度（ｐｅａｋｓｙｓｔｏｌｉｃｖｅｌｏｃｉｔｙ，ＰＳＶ）、舒张末期血流速度（ｅｎｄ－ｄｉａｓｔｏｌｉｃｖｅｌｏｃｉｔｙ，ＥＤＶ）和血管搏动指数（ｐｕｌｓａｔｉｌｉｔｙｉｎｄｅｘ，ＰＩ），ＣＲＶ最大血流速度（ｍａｘｉｍｕｎｖｅｌｏｃｉｔｙ，Ｖｍａｘ）。结果ＲＶＯ患眼、对侧临床健康眼ＣＲＡ的ＰＳＶ和ＥＤＶ均显著低于正常对照眼，ＲＶＯ患眼ＰＩ显著高于正常对照眼；ＲＶＯ患眼ＣＲＡ的ＰＳＶ显著低于ＲＶＯ对侧临床健康眼，ＲＶＯ患眼ＰＩ显著高于ＲＶＯ对侧临床健康眼；ＲＶＯ患眼、对侧临床健康眼ＣＲＶ的Ｖｍａｘ均显著低于正常对照眼。结论ＲＶＯ患眼和对侧临床健康眼血流动力学异常。彩色多普勒成像技术可作为其早期诊断的重要手段     

Arterial blood flow characteristics in central retinal vein occlusion and effects of panretinal photocoagulation treatment: an investigation by colour Doppler imaging

AIMS: To determine whether an increase in vascular resistance in the central retinal and ophthalmic arterial circulations contributes to the development of central retinal vein occlusion (CRVO), or haemodynamic alterations in central retinal and ophthalmic arteries occur secondary to the vein occlusion as increased intravascular pressure is transferred through the capillary bed to the arterial side and the effect of panretinal photocoagulation treatment on these circulations in ischaemic cases. METHODS: The ophthalmic and central retinal arteries of the affected and non-affected eyes of 20 patients with non-ischaemic CRVO, 13 patients with ischaemic CRVO, and 22 control subjects were investigated by colour Doppler imaging. Panretinal photocoagulation (PRP) treatment was applied to the eyes with ischaemic CRVO. Maximum and minimum blood flow velocities, and resistivity indexes were calculated in the affected and healthy eyes of patients and in the control eyes. RESULTS: Average blood flow velocity in the central retinal and ophthalmic arteries of patients with non-ischaemic CRVO did not differ from their fellow eyes, but a significantly lower average blood flow velocity was found in the ophthalmic and central retinal arteries of the patients with ischaemic CRVO compared with their fellow eyes. Patients with ischaemic CRVO had significantly lower blood flow velocities in their ophthalmic and central retinal arteries than non-ischaemic cases that were further reduced following PRP treatment. CONCLUSION: This study suggests that impaired arterial blood flow observed in patients with CRVO may be partly related to secondary changes in the retrobulbar arterial circulation as a result of enhanced arterial resistance following CRVO. These data also demonstrate that PRP treatment decreases retinal and ophthalmic blood flow velocities in patients with ischaemic CRVO.     

Investigation of blood flow velocity by color Doppler imaging in nonischemic central retinal vein occlusion with collateral veins

PURPOSE: To study the blood flow velocity in the central retinal vein after the resolution of non-ischemic central retinal vein occlusion (CRVO) with optociliary vein (OCV). METHODS: Eleven patients and 22 healthy volunteers were studied. Indocyanine green (ICG) angiography was used to investigate the choroidal veins in the affected eyes. Color Doppler imaging was used to measure the blood velocity in the central retinal artery and vein in the 11 affected and 22 healthy eyes. RESULTS: Indocyanine green angiography verified the formation of retinochoroidal collaterals in all the affected eyes. The velocity in the central retinal vein was significantly lower in the affected eyes. CONCLUSIONS: The results indicate that the collaterals are important routes of extraretinal outflow of retinal venous blood. It is recommended in the investigation of CRVO by color Doppler imaging to perform ICG angiography to determine if retinochoroidal collateral veins have been formed.     

Retinal vein occlusion and carotid Doppler imaging

PURPOSE: To investigate retinal vein occlusion with B-mode ultrasonography carotid and color Doppler imaging. METHODS: In 223 patients (225 eyes) presenting with retinal vein occlusion, we retrospectively investigated vascular risk factors (hypertension, diabetes, hyperlipidemia, cardiovascular history, smoking, and glaucoma), standard laboratory tests, and color Doppler imaging of the carotid artery. RESULTS: The data from 106 women (47.54%) and 117 men (52.46%), with a mean age of 65 years, were studied, with 169 patients presenting a central retinal vein occlusion (CRVO) and 56 a branch retinal vein occlusion (BRVO). Thirteen patients (6%) had significant carotid artery stenosis (>=70%), which was the single etiology. Forty patients (18%) had nonsignificant carotid artery stenosis (<70%) with a risk of embolism production. Such carotid artery lesions found in color Doppler imaging in the RVO investigations were significantly more frequent in older patients (>65 years) who presented at least two RVO risk factors (p<0.001). CONCLUSION: This study has shown the the advantages of carotid Doppler imaging in retinal vein occlusion.     

多焦视网膜电图及彩色多普勒在视网膜脱离术患者中的应用

目的：通过对视网膜脱离患者术前、术后的血流动力学研究及视网膜功能的了解,判断视网膜脱离患者的术后恢复情况,并探讨两种检测方法的临床价值。 方法：对我院62例孔源性视网膜脱离患者,通过彩色多普勒（CDI）检测视网膜中央动脉（CRA）的收缩期峰值流速（Vmax）、舒张末期流速（Vmin）、阻力指数（RI）;多焦视网膜电图（mfERG）分别对视网膜脱离患者的术前、术后进行检测,并以对侧正常眼作对照组。 结果：CDI术前患眼与对照眼的CRA各项指标比较,差异无统计学意义。术后2wk视网膜脱离眼CRA的Vmax,Vmin均较术前降低,RI增高,差异有统计学意义（P<0.05）。视网膜脱离术后患者脱离区mfERG的a波、b波振幅密度均明显高于术前,潜伏期比手术前明显缩短,有统计学意义（P<0.05）。 结论：通过mfERG,CDI的联合检测能及时了解视网膜脱离术后的视网膜复位情况及硅胶海绵垫压后CRA的血流情况,从而避免视网膜脱离术后视网膜部分复位不良,巩膜因缺血引起局部坏死等情况发生。     

Multifocal electroretinograms in patients with retinal vein occlusion

PURPOSE: To investigate waveform changes of multifocal electroretinograms(mERG) in patients with retinal vein occlusion(RVO). METHODS: Nine eyes of 8 patients with RVO and 29 eyes of 29 normal subjects were examined using mERG. An array of 103 hexagonal elements was displayed on a monitor. mERG latencies(ms) and response densities (nV/deg2) were measured for center area(Ct) and for each of four quadrant areas. The peak and troughs were named N1, P1 and N2, consecutively. RESULTS: In pathological quadrants, although the response densities were abnormal in only one eye, latencies of the N2 and P1 were prolonged in 7 eyes and in 2 eyes, respectively(over 1 SD-2 SD). The latencies were significantly prolonged compared with those of normal eyes(p < or = 0.03, U-test). On the other hand, in the central area, although the latencies were abnormal in 3 eyes, the response densities were reduced in 6 eyes(over 1 SD-2 SD). The response densities were significantly reduced compared with those of normal eyes(p < or = 0.024, U-test). CONCLUSIONS: Both peak latencies in pathological quadrants and response densities in the central retinal area can be sensitive indicators of retinal dysfunction caused by RVO. The mERG system is useful for detecting local retinal dysfunction in patients with RVO.     

应用炫彩成像技术观察视网膜分支静脉阻塞患者动静脉交叉压迫点的临床意义

目的　探讨利用炫彩视网膜成像技术观察视网膜分支静脉阻塞（BRVO）患者动静脉交叉压迫点的可行性及其临床意义。方法　前瞻性研究。纳入2019年7月至2020年10月就诊于遵义医科大学第二附属医院眼科门诊的BRVO患者49例49眼。散瞳后分别行传统彩色眼底照相、基于共焦扫描激光检眼镜的海德堡炫彩成像（MultiColor）以及荧光素眼底血管造影（FFA）检查,以FFA图像为依据观察动静脉交叉压迫点,利用Spectralis HRA-2炫彩成像对压迫点所处的血管进行分级评分并测量压迫点距视盘血管发出区的距离。根据FFA结果将BRVO患者分成缺血型组和非缺血型组,对比两组患者上述指标差异。 结果　炫彩成像观察到的BRVO患者动静脉交叉压迫点与FFA图像结果一致,49例患者均为视网膜颞侧分支静脉阻塞,颞上分支阻塞者33例,颞下分支阻塞者16例,缺血型组与非缺血型组患者阻塞部位相比差异无统计学意义（P＝0.289）。缺血型组患者压迫点血管分级评分平均为1.0分,与非缺血型患者的血管分级评分平均2.5分相比,差异有统计学意义（P=0.001）。压迫点距视盘血管发出区的距离缺血型组为（2543.00±769.06）μm,非缺血型组为（3505.44±1125.42）μm,两组比较差异有统计学意义（P＝0.002）,压迫点血管分级评分与BRVO是否发生缺血相关（P=0.003）。结论　基于共焦扫描激光检眼镜的海德堡炫彩成像技术可以直观地观察BRVO患者动静脉交叉压迫点而不受出血的影响,并可以对压迫点血管进行分级评分,有助于为BRVO患者的治疗及预后评估提供更全面准确的信息。     

Choroidal thickening in retinal vein occlusion patients with serous retinal detachment

Graefe's Archive for Clinical and Experimental Ophthalmology - To evaluate choroid thickness and macular retinal metrics in treatment naïve retinal vein occlusion (RVO) patients with...     

Embolic central retinal artery occlusion detected by orbital color Doppler imaging

OBJECTIVE: To describe the detection of emboli to the retrobulbar circulation using orbital color Doppler imaging in patients with central retinal artery occlusions (CRAO) without visible retinal emboli. DESIGN: Noncomparative, retrospective, observational case series. PATIENTS AND METHODS: Twenty-nine patients with CRAO, without funduscopic evidence of embolic material within the retinal arterioles, underwent neuroophthalmic examination and evaluation with orbital color Doppler imaging. MAIN OUTCOME MEASURES: The detection of retrobulbar plaques using orbital color Doppler imaging. RESULTS: Nine of 29 (31%) patients with CRAO demonstrated hyperechoic retrobulbar plaques. All nine patients had visual acuity of counting fingers or worse at presentation. Six of the nine patients (67%) had a history of hypertension, and seven (78%) had coronary artery disease as vascular risk factors for arterial occlusive disease. Two of the nine patients (22%) subsequently died from cardiac-related events. CONCLUSIONS: This study demonstrates that orbital color Doppler imaging is an important diagnostic procedure for establishing embolism as the cause of CRAO when no emboli are visible in the retinal circulation. This noninvasive technology enables prompt differentiation of embolic disease from arterial occlusion caused by intrinsic atherosclerosis, vasospasm, or vasculitis from giant cell arteritis. Recognition of emboli has important management implications for these patients.     

Cardiovascular risk assessment in patients with retinal vein occlusion

AIM: Patients with retinal vein occlusions (RVO) are at increased risk of cardiovascular disease (CVD). The risk of future CVD was determined using the Framingham algorithm and this risk estimate was used to guide decisions about preventative treatment for CVD in RVO patients. METHODS: 107 unselected RVO patients were studied. After excluding 18 patients because of age, missing data, or pre-existing cardiovascular disease, the calculated coronary heart disease risks (cCHDR) and calculated cardiovascular disease risks (cCVDR) were calculated on the 89 remaining and compared with both the standardised risk and the published incidence of CHD in England by t test or chi(2) test. RESULTS: The mean 10 year cCVDR was significantly higher than the Framingham standardised risk for all RVOs (20.6% (1.2%) v 15.7% (1.1%), p = 0.009) and female RVOs (17.8% (1.2%) v 12.7% (1.0%), p = 0.022) in particular. The 10 year cCHDR, compared to the actual incidence of CHD in England between the ages of 30 and 74 years, was > 15% in twice as many males than expected (62% v 28%, p <0.0001). This rose to almost six times when cCHDRs greater than 30% were compared (17% v 3%, p = 0.002). There was a fourfold increase in the proportion of female RVO patients with a cCHDR above 15% (40% v 9%, p <0.0001) and at a cCHDR of 30% and above (10% v 0%, p = 0.004). There were also significant differences in the cCHDR between central and branch RVO (both sexes). The branch form of RVO (BRVO) having higher cCHDRs because of systolic hypertension (164.1 (21.6) mm Hg v 149.5 (23.5) mm Hg, p = 0.003) and age (61.7 (8.3) years v 56.7 (10.6) years, p = 0.017). CONCLUSIONS: RVO is the presenting complaint in a group of patients at increased risk of CVD and is in agreement with the long term follow up data demonstrating an increased mortality from CVD in patients with RVO. The Framingham algorithm can accurately determine the cCHDR (or cCVDR) to assist the clinician in deciding who to treat in accordance with the Joint British Societies' guidelines, with particular regard to hypertension, lipid lowering, and the use of aspirin therapy.     

Perimetric sensitivity with the micro perimeter 1 and retinal thickness in patients with branch retinal vein occlusion

PURPOSE: To evaluate the relationship between retinal sensitivity and thickness of the macular edema associated with branch retinal vein occlusion (BRVO). DESIGN: Prospective case series. METHODS: We prospectively examined 15 eyes of 15 patients with macular edema associated with BRVO. In each patient, retinal sensitivity in the macular area was examined with the Micro Perimeter 1 (MP-1); retinal thickness was measured by optical coherence tomography (OCT). Eyes with marked retinal hemorrhage or macular nonperfusion were excluded from the current study. RESULTS: Retinal sensitivity measured with the MP-1 was significantly correlated with retinal thickness in the fovea (R(2) = 0.460) and in all extrafoveal regions (R(2) = 0.383 to 0.794). In four eyes treated with triamcinolone acetonide, retinal sensitivity showed marked improvement in parallel with the reduction of the macular edema. CONCLUSIONS: Retinal sensitivity in the macular area correlates linearly and negatively with increased retinal thickness in eyes with BRVO.     

Colour Doppler assessment of blood flow in eyes with central retinal vein occlusion

PURPOSE: To assess the blood flow changes in eyes with central retinal vein occlusion (CRVO) and compare these values with values of fellow eyes and eyes of normal subjects. METHODS: 25 eyes of 25 consecutive newly diagnosed patients with CRVO comprised the study group. Their fellow eyes and those of 25 healthy subjects were the control group. All patients underwent a complete ophthalmological examination. Eyes with CRVO were classified into two groups as non-ischaemic and ischaemic by fundus fluorescein angiography. Colour Doppler imaging was performed with a Toshiba Sonolayer SSH-140A and 7.5-MHz linear array probe. Maximum systolic velocity (V(max)), end-diastolic velocity (V(min)) and resistive index (R(i)) values were noted for each of the central retinal artery (CRA), central retinal vein (CRV) and ophthalmic artery (OA). These parameters were compared with those of the fellow eyes and both eyes of the control group. RESULTS: Mean ages were 63.55 and 61.45 years in the CRVO and control groups, respectively. Age and sex distributions were statistically identical in both groups. When we compared the eyes with CRVO to the control group, no statistically significant difference existed between the two groups with regard to the V(min) and R(i )values of the CRA and CRV. However, V(max ) values of the CRA and CRV were significantly lower in CRVO eyes when compared to the control group. The CRVO group and control group had similar V(max), V(min ) and R(i) values for the OA. Only the V(max) was significantly lower in the CRV in eyes with CRVO when compared to the unaffected fellow eyes. No statistically significant difference could be detected between any of the parameters of CRA, CRV and OA of the ischaemic and non-ischaemic CRVO groups. CONCLUSIONS: More data on broader series need to be obtained in order to decide on the practical use of colour Doppler imaging in the differentiation of ischaemic eyes from non-ischaemic eyes in CRVO.     

视网膜静脉阻塞激光治疗后玻璃体出血的临床分析

目的：了解视网膜静脉阻塞(RVO)激光治疗后发生玻璃体出血的原因。方法：回顾分析2年来门诊11例(11眼，CRVO：2眼；BRVO：9眼)激光后的视网膜静脉阻塞发生玻璃体出血的病例。结果：11例RVO中：少量玻璃体出血5例；中-多量玻璃体出血6例，其中2例作玻璃体切除术，其余激光治疗后出血停止而治愈。由初次激光治疗到玻璃体出血时间6月-11年，再次激光或／和手术后视力均有改善。结论：不规范或不完全的视网膜光凝是导致RVO激光治疗发生玻璃体出血的主要原因，规范的视网膜光凝、定期随诊和眼底荧光造影是保证疗效的关键。