开放性眼外伤患者行Ⅱ期玻璃体切除手术的时机选择

目的： 观察开放性眼外伤不同时间点行玻璃体切除手术的临床疗效,以探讨Ⅱ期玻璃体手术的时机选择。

方法：回顾性系列病例研究。纳入2022-06/2023-02就诊于我院眼科的开放性眼外伤患者60例60眼,按Ⅰ期规范化急诊救治手术时间与Ⅱ期玻璃体视网膜手术的不同间隔时间分为治疗组A(间隔时间≤14 d,32例32眼)和治疗组B(间隔时间>14 d,28例28眼)。治疗组A中眼球破裂伤16眼(50%),穿通伤13眼(41%),贯通伤3眼(9%); 治疗组B中眼球破裂伤15眼(54%),穿通伤12眼(43%),贯通伤1眼(4%)。术后随访6 mo,对比观察两组患者的治疗效果。

结果：玻璃体切除手术前两组患者间视力无差异(P>0.05)。术后6 mo,治疗组A中10眼(31%)视力显著提高,21眼(66%)视力有效提高,1眼(3%)视力无改善; 治疗组B中,5眼(18%)视力显著提高,16眼(57%)视力有效提高,7眼(25%)视力无变化,两组比较有差异(U=322.5,P=0.032)。治疗组A中继发性青光眼、硅油依赖、玻璃体再积血、眼球萎缩与治疗组B比较无显著差异(均P>0.05); 治疗组A术后随访未见外伤性增生性玻璃体视网膜病变(TPVR),显著低于治疗组B(P<0.05)。

结论：开放性眼外伤Ⅱ期玻璃体视网膜手术在Ⅰ期救治手术后2 wk内完成预后相对较好。     

开放性眼外伤早期行玻璃体切除术的可行性及意义

目的:探究开放性眼外伤患者早期行玻璃体切除术的可行性及意义。方法:回顾性分析2018-03/2019-03在本院眼外科治疗的开放性眼外伤合并视网膜脱离患者82例82眼,根据眼外伤发生后行玻璃体切除术的时间分为早期组(7d内)和常规组(7~14d),术后随访3mo,比较两组患者的总体疗效、视力变化、视网膜剥离复位率、外伤性增殖性玻璃体视网膜病变(TPVR)和并发症情况。结果:早期组总治愈率、视力提高率分别为93%、95%,常规组分别为71%、76%,早期组均显著高于常规组(χ2=5.222、4.783,P<0.05)。早期组硅油依赖、玻璃体再出血、继发性青光眼发生率分别为5%、10%、5%,常规组分别为27%、39%、29%,早期组均显著低于常规组(P<0.05);两组患者视网膜剥离复位率无差异(P>0.05),而早期组TPVR发生率为5%,常规组为20%,早期组低于常规组,但是差异无统计学意义(P>0.05)。结论:对于开放性眼外伤合并视网膜脱离患者,早期行玻璃体切除术的预后效果更佳,可提高视网膜复位率并降低TPVR的发生率。     

25G和27G玻璃体切除术联合空气填充治疗RRD的疗效比较

目的：对比25G和27G玻璃体切割术(PPV)联合无菌空气填充治疗孔源性视网膜脱离(RRD)的临床疗效和安全性。

方法：回顾性分析2016-05/2018-06在我院行PPV联合空气填充治疗的RRD患者63例63眼,其中25G组33例33眼,27G组30例30眼。对比分析两组术前和术后BCVA(LogMAR)、眼压、手术时间、视网膜复位率及并发症发生情况。

结果：两组术前的基线资料均无差异(P>0.05)。25G组与27G组末次随访的BCVA均较术前改善(均P<0.01),但两组间视力改善幅度无差异(P>0.05)。25G组和27G组的平均手术时间分别为44.13±5.9、46.07±6.1min(t=0.028,P=0.412)。25G和27G组视网膜复位率分别为91%、93%(χ²=0.015,P=0.902)。25G和27G组术后发生一过性低眼压(<6mmHg)的分别为5眼(15%)和3眼(10%)(χ²=0.376,P=0.540)。两组均未观察到脉络膜脱离、感染性眼内炎等严重并发症。

结论：27G PPV联合空气填充治疗RRD在手术时间、视网膜复位率、视力改善及并发症方面与25G无差异,是治疗RRD安全、经济而有效的手术方式。     

雷珠单抗对PDR患者玻璃体切割术后疗效的影响

目的：探讨PDR患者给予雷珠单抗辅助25G玻璃体切割术治疗后的临床疗效。

方法：选取2014-10/2017-11于我院就诊的PDR患者120例120眼作为研究对象。常规组患者60例60眼给予单纯25G玻璃体切割术治疗,研究组患者60例60眼给予雷珠单抗辅助25G玻璃体切割术治疗。术后随访6mo,对比两组患者手术时长、术中与术后情况、术后并发症,以及术前、术后6mo时BCVA、眼压、黄斑中心区厚度变化。

结果：研究组手术平均时长显著低于常规组(t=5.727,P<0.05); 研究组术后高眼压、出血明显且需电凝、医源性视网膜裂孔、虹膜新生血管发生率均低于常规组(P<0.05); 研究组术后并发症总发生率(5.0%)低于常规组(16.7%),两组间有统计学差异(χ²=4.227,P<0.05)。研究组术后6mo眼压和黄斑中心区厚度低于常规组,BCVA优于常规组(t=3.362、2.486、8.028,均P<0.05)。

结论：PDR患者给予雷珠单抗辅助25G玻璃体切割术治疗可有效缩短手术时间,改善黄斑水肿情况,减少术后出血和并发症发生率。     

两种手术方法治疗非后极部多发裂孔性视网膜脱离的比较

目的：观察非后极部多发裂孔性视网膜脱离的临床特征,探讨玻璃体切割术和巩膜扣带术的疗效。

方法：回顾性分析2017-06/2018-08在我院眼科住院行手术治疗的非后极部多发裂孔性视网膜脱离患者40例40眼,按手术方式不同分为玻璃体切割术(PPV)组(18眼)和巩膜扣带术(SB)组(22眼)。术后随访3～6mo,观察两组患者的手术疗效。

结果：至末次随访,PPV组患者视网膜复位率为100%(18/18),去除硅油填充眼后视网膜复位率为56%(10/18)。SB组患者视网膜复位率为86%(19/22),无硅油填充眼。两组患者视网膜复位率比较(包括硅油填充眼),差异无统计学意义(P>0.05),去除硅油填充眼后视网膜复位率比较有差异(P<0.05)。

结论：非后极部多发裂孔性视网膜脱离多为视网膜广泛变性或合并玻璃体牵拉引起。复杂病例宜选择玻璃体切割术,但需多次手术,而巩膜扣带术远期效果稳定。两种手术方法各有利弊,应综合考虑,不应盲目扩大玻璃体切割术适应证。对于年轻或独眼等特殊群体,如有可能应尽可能优先选择巩膜扣带术。     

玻璃体切割联合人工晶状体植入术治疗糖尿病视网膜病变合并白内障

目的：探讨玻璃体切割联合Ⅰ/Ⅱ期人工晶状体植入术治疗糖尿病视网膜病变合并白内障的临床疗效和安全性。

方法：选取2015-03/2017-04于我院手术治疗糖尿病视网膜病变合并白内障的患者67例76眼,根据手术方式不同分为A组(Ⅰ期玻璃体切割+晶状体超声乳化摘除+硅油填充+人工晶状体植入术,Ⅱ期硅油取出术)和B组(Ⅰ期玻璃体切割+晶状体超声乳化摘除+硅油填充,Ⅱ期硅油取出+人工晶状体植入术)。比较两组患者视力改善、眼压及术后并发症情况。

结果：术后3mo,两组患者视力改善情况无差异(P>0.05)。术前和术后3mo,两组患者眼压无明显变化(P>0.05)。两组患者玻璃体出血(3% vs 5%)、脉络膜出血(0% vs 2%)、视网膜脱落(6% vs 2%)、视网膜裂孔(6% vs 10%)发生率均无明显差异(P>0.05)。

结论：玻璃体切割联合Ⅰ/Ⅱ期人工晶状体植入术治疗糖尿病视网膜病变合并白内障疗效无明显差异。     

保留晶状体前囊膜的玻璃体切除术联合超全视网膜光凝治疗PDR

目的：探讨保留晶状体前囊膜的玻璃体切除术联合术中超全视网膜光凝在增殖型糖尿病视网膜病变(PDR)Ⅵ期合并白内障的临床应用。

方法：回顾性分析2010-01/2013-06于我院收治的PDRⅥ期合并白内障患者38例45眼,术前视力均为光感至0.1,入院后行保留晶状体前囊膜的玻璃体切除术,术中行超全视网膜光凝(E-PRP),术毕所有眼均行硅油填充,术后随访12～26mo,观察眼压、视力、眼前节及眼后节情况。

结果：术后32眼(71%)视力提高,13眼(29%)视力未提高,BCVA≥0.05的有23眼,较术前有显著差异(χ²=16.80,P<0.01),39眼(87%)视网膜复位良好,2眼(4%)出现硅油依赖眼,7眼(16%)合并视网膜前增殖膜。术后1眼(2%)虹膜新生血管(INV)进展为新生血管性青光眼,4眼INV逐渐消退,但较术前差异无显著性(χ²=1.61,P=0.21)。术后出现一过性高眼压11眼(24%),一过性角膜水肿8眼(18%),前房纤维渗出6眼(13%),虹膜后粘连2眼(4%),前囊膜混浊13眼(29%)。

结论：对于PDRⅥ期合并白内障的患者,保留晶状体前囊膜的玻璃体切除术联合术中超全视网膜光凝是安全有效的,能提高术后视力,有效地复位视网膜。同时可能减少INV的发生。     

27G与25G微创玻璃体切除术术后短期指标对比分析

目的：比较27G与25G微创玻璃体切除术治疗玻璃体视网膜疾病术后短期指标,探讨27G微创玻璃体切除术的可行性、安全性及实用性。

方法：回顾性分析2016-04/2017-10在我院行27G与25G微创玻璃体切除术治疗玻璃体视网膜疾病患者217例217眼的临床资料,其中27G组135例,25G组82例。分析两组患者手术时间、术中并发症、术后眼部炎症反应、最佳矫正视力(BCVA)恢复及眼压波动等情况。

结果：两组患者均顺利完成手术,27G组无患者术中需改为25G玻璃体切除术。25G组手术时间平均56.4±38.9min,27G组45.5±26.1min,差异有统计学意义(t=2.422,P=0.016),但两组中相同疾病的患者手术时间分别比较,差异均无统计学意义(P>0.05)。术后1wk内,25G组结膜充血、前房闪辉及房水细胞累积评分平均为2.4±1.4、0.7±1、0.5±1分,均高于27G组的相应指标的平均累积评分2.1±1.6、0.3±0.6、0.2±0.4分,差异具有统计学意义(P=0.038、0.011、0.046)。术后第7d,25G组BCVA(LogMAR)较术前改善-0.4±0.9,27G组BCVA(LogMAR)较术前改善-0.2±0.9,差异无统计学意义(t=-1.636,P=0.103)。术后1wk内,25G组发生一过性低眼压16眼(19.5%),27G组21眼(15.6%),差异无统计学意义(χ²= 0.565,P=0.452); 去除硅油填充的病例后,25G组眼压波动(3.59±0.69mmHg)与27G组(3.58±0.47mmHg)比较,差异无统计学意义(t=0.007,P=0.995)。

结论：27G微创玻璃体切除术可用于多种视网膜玻璃体疾病的治疗,具有创伤小、手术反应轻等特点,是治疗玻璃体视网膜疾病的一种安全、实用的手术方式。     

上方球形视网膜脱离术中行玻璃体内BSS注入与术毕空气充填效果比较

目的：观察巩膜外放液后术中行玻璃体内平衡盐溶液(BSS)注入适当升高眼压,再行巩膜外垫压(SB)治疗原发性上方球形视网膜脱离(SBRD)的效果,并与常规术式(无任何玻璃体内填充)及术毕玻璃体内注入消毒空气的效果进行比较。

方法：回顾性病例对照研究。2018-01/2022-12因SBRD在西京医院眼科行SB治疗的72例73眼患者被纳入研究。所有患者术中均行巩膜外放液。根据放液后是否行玻璃体注射升高眼压和注射物不同,患者被分为三组：常规手术组不做任何玻璃体内注射24例24眼、术毕注入消毒空气组(空气组)23例23眼,以及术中注入BSS组(BSS组)25例26眼。所有患者至少随访至视网膜下液完全吸收。比较各组平均手术时间、术后早期眼压、视网膜复位、视网膜下液吸收、视力(LogMAR)和主要并发症等差异。

结果：所有患者均顺利完成手术。常规手术组、空气组和BSS组平均手术时间分别为63.17±13.22、61.65±15.55、57.30±11.70 min,三组间无差别(F=0.825,P=0.443)。术后1 d,常规手术组、空气组和BSS组平均眼压分别为13.69±2.69、16.40±2.86、18.35±2.88 mmHg,空气组和BSS组平均眼压高于常规手术组(F=17.18,P<0.001)。三组中单次手术的视网膜复位率分别为88%、96%和100%。术后1 d,常规手术组、空气组和BSS组平均BCVA分别为0.71±0.42、0.59±0.44、0.91±0.50,均较术前提高(均P<0.05),而三组间无差别(F=3.046,P>0.05)。手术后,常规手术组和空气组分别有1眼出现视网膜下出血,空气组1眼出现新裂孔而导致局限性视网膜脱离。

结论：针对SBRD患者SB术中放液后出现的低眼压,采取BSS玻璃体内注射适当升高眼压再完成手术,可提高手术成功率,减少术后并发症。这种方法对经选择的SBRD患者是安全和有效的。     

雷珠单抗辅助微创玻璃体切割术治疗严重PDR的临床研究

目的：观察雷珠单抗(Ranibizumab)辅助微创玻璃体切割术(pars plana vitrectomy,PPV)治疗严重增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效。

方法：选取2014-06/2016-07在我院就诊且行23G/25G微创玻璃体切割治疗的严重PDR患者56例56眼的临床资料进行回顾性分析,将术前5～7d行玻璃体腔注射雷珠单抗(intravitreal injection of ranibizumab,IVR,0.5mg/0.05mL)且联合微创PPV者30眼分为A组,将接受单纯微创PPV者26眼分为B组。统计分析两组患者术眼手术操作持续时间、术中出血情况、术中使用电凝次数、医源性视网膜裂孔发生率和术后最佳矫正视力(best corrected visual acuity,BCVA)的差异。术后随访6mo。

结果：A组患者手术时间明显短于B组,两组比较差异有统计学意义(98.10±14.23min vs 113.89±17.66min,t=3.703,P=0.0005)。术中A组患者出血眼数明显少于B组,两组比较差异有统计学意义(20% vs 54%,χ²=6.95,P=0.0084)。A组患者术中平均使用电凝次数明显少于B组,两组比较差异有统计学意义(1.30±1.15次vs 2.73±1.71次,t=3.72,P=0.001)。术中A组患者医源性视网膜裂孔发生率明显少于B组,两组比较差异有统计学意义(7% vs 27%,χ²=4.24,P=0.0396)。术后1mo时A组BCVA提高率较B组高,但两组比较差异无统计学意义(87% vs 73%,χ²=1.630,P=0.202)。

结论：雷珠单抗辅助微创玻璃体切割术治疗严重PDR可降低术中出血,减少术中电凝使用次数,明显缩短手术时间,减少医源性视网膜裂孔的发生率,而术后最佳矫正视力提高率与单纯微创玻璃体切割术组比较无明显差异。     

Retinal dialysis

Retinal dialysis is a disinsertion of the sensory retina at the ora serrata. Dialysis may result from ocular trauma or occur as a spontaneous non-traumatic event. Dialyses are often asymptomatic and associated with a slowly progressing secondary retinal detachment. They show a predilection for the inferotemporal retinal quadrant. Retinal dialysis is the major cause of retinal detachment in children and young adults. Two cases of spontaneous retinal dialysis are presented. These cases represent extremes of the age spectrum for this condition.     

The effect of caffeine on retinal vessel diameter in young healthy subjects

Purpose: To investigate the effect of caffeine on retinal vessel diameter before and during flicker light stimulation in young healthy subjects. Methods: Seventeen healthy subjects (mean age: 29.6 ± 3.73 years, range: 22–35 years) were included in this study. The diameter of retinal vessels was measured continuously with the retinal vessel analyzer (RVA) before and 1 hr after 200 mg oral caffeine intake. After baseline assessment, a green luminance flicker of 20‐second duration was applied to stimulate retinal activity. The diameter of a segment of an arteriole and of a venule were measured during stimulation and 80 second after cessation of the stimulus. Flicker stimulation and 80‐second measurement interval were carried out three times. Blood pressure parameters, systemic mean arterial pressure (MAP), ocular perfusion pressure (OPP) and intraocular pressure (IOP) were obtained before and after oral caffeine intake. Results: The mean diameter of the arterioles at baseline before caffeine intake was 123.30 ± 14.0 μm (arithmetic mean ± standard deviation) and after caffeine 117.30 ± 13.0 μm which was significantly different (p = 0.004). The mean diameter of the venules at baseline before caffeine intake was 147.60 ± 19.5 μm and after caffeine 137.73 ± 19.9 μm which was significantly different (p = 0.005). The mean diameter of the arterioles during flicker light stimulation before caffeine intake was 126.65 ± 13.24 μm and after caffeine intake 121.59 ± 12.12 μm (p = 0.012). The mean diameter of the venules during flicker light stimulation before caffeine intake was 151.87 ± 18.63 μm and after caffeine intake was 145.14 ± 19.82 μm (p = 0.027). The flicker response of the arterioles increased from 2.8% before caffeine to 3.8% after caffeine intake (p = 0.010). The flicker response of the venules increased from 3.4% before caffeine to 5.5% after caffeine intake (p = 0.0001). Baseline diameters and diameters during flicker light stimulation after caffeine intake showed a significant negative correlation to the MAP for the arterioles (baseline: r = ?0.338, p = 0.049 and flicker: r = ?0.345, p = 0.046) and the venules (baseline: r = ?0.496, p = 0.003 and flicker: r = ?0.479, p = 0.004). Conclusions: The present study showed a significant vasoconstrictory response of the retinal vessels 1 hr after caffeine intake in young healthy subjects. Retinal vessel diameter changes were negatively correlated with MAP after caffeine consumption. These effects seem to be elicited by an autoregulatory response of the retinal vessels to the increased blood pressure changes after caffeine.     

实验性视网膜脱离复位后的视网膜细胞超微结构观察

目的 研究视网膜脱离复位后视网膜超微结构改变,以探讨视功能恢复障碍的机制。方法 12只灰兔通过在视网膜下注射透明酸钠的方法建立视网膜脱离模型。用透射电镜观察术后1,2,3,4周的视网膜。结果 视网膜复位早期光感受器外节段缺失、断裂。内节、视细胞核、双极细胞、神经节细胞均可见胞浆水肿,线粒体肿胀和嵴断裂。复位3周后,视网膜细胞结构基本正常,但仍有部分外节变短,神经纤维空洞存在。结论 视网膜复位后不仅光感受器,而且视网膜其他细胞和神经纤维均有不可逆的改变,这些改变导致视功能恢复不良。     

视网膜脱离巩膜扣带术后后极部视网膜定量分析

目的:研究视网膜脱离(retinal detachment,RD)巩膜扣带术后后极部视网膜水肿情况。方法:应用视网膜厚度分析仪(RTA)对38例38眼孔源性RD巩膜扣带术后手术成功眼后极部视网膜厚度进行测量。结果:术后进行RTA测量随访的时间为72.61±57.27d,经RTA测量,RD术后黄斑中心凹平均厚度168.03±38.27μm,与对侧眼比较二者差异无显著性(P>0.05);RD眼术后后极部平均厚度175.50±33.85μm,与对侧眼比较二者差异无显著性(P>0.05),RD眼术后后极部最大厚度(310.18±158.40μm)与对侧眼比较,二者差异有显著性(P<0.01)。结论:通过RTA可精确测量并观察后极部视网膜水肿发生情况,视网膜脱离巩膜扣带术后2mo后极部视网膜局限性水肿仍存在,术后这个时间患者仍存在视物变形与此有关,仍需进行进一步的长期随访观察后极部视网膜水肿消退的时间。而且,在这段时间内考虑给予相应的干预治疗,以改善视功能。     

Aggregations of retinal pigment epithelial cells on inferior retinal blood vessels,a clinical sign of early proliferative vitreoretinopathy

Purpose: To determine the relationship between ‘pigment clusters’ on blood vessels (BvRPE) on the inferior retina in patients with rhegmatogenous retinal detachment, and existing proliferative vitreoretinopathy (PVR). Methods: A prospective observational non‐comparative study of consecutive patients presenting with rhegmatogenous retinal detachment to a tertiary referral university department was performed. The retina was inspected preoperatively for the detection of BvRPE. A relationship with existing PVR was determined. Results: A total of 103 patients were recruited, 70 men and 32 women, mean age 56.7 years, with 57 left eyes. Mean duration of follow up was 9.2 months. Nineteen patients (18.4%) had BvRPE, and 20 had RPE clusters off blood vessels (nine had both). In those with the sign of BvRPE the mean number of RPE clusters on blood vessels was 5.7 (SD 5.8). The mean number of clock hours affected was 2.32 (SD = 1.58). Eight had B grade PVR and three C grade PVR. Patients with BvRPE were more likely to have PVR grades B or C than those without the sign (P = 0.002). The mean number of operations in those with the sign was 1.32 (SD = 0.58) and was statistically similar to those without BvRPE. Visual outcome was statistically similar in those with and without the sign. Conclusion: Patients with rhegmatogenous retinal detachment may demonstrate ‘pigment clusters’ on blood vessels in the inferior retina (BvRPE). This is likely to be a specific feature found in PVR and an early sign of activation of retinal pigment epithelial cells.     

兔眼视网膜铁锈症的实验观察

在光镜和电镜下观察了25只兔眼植入铁异物1～30天的视网膜变化。结果表明,邻近铁异物的局部视网膜2天即发生变性坏死,7～30天坏死的部分由视网膜色素上皮细胞(RPE)和胶质细胞填充,形成视网膜重度萎缩。在间接铁锈症的轻度萎缩性视网膜病变中,导致感光细胞形态学改变的重要原因,可能是RPE吞噬功能异常增高。观察了RPE转变为吞噬细胞,向玻璃体侧移行的过程。     

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Retinal vein occlusion (RVO)-including central RVO, branch RVO, and hemicentral and hemispheric RVO—is the second most common vascular cause of visual loss, surpassed only by diabetic retinopathy. The presence and extent of retinal ischemia in RVO is associated with a worse prognosis. On this basis, most previously conducted studies considered ischemic retinal vein occlusion (iRVO) and non-iRVO as separate entities based on set thresholds of existing retinal ischemia as determined by fundus fluorescein angiography. Other diagnostic technologies have been used specifically in the differentiation of ischemic central retinal vein occlusion and nonischemic central retinal vein occlusion. To date, there is no fully accepted definition for iRVO. Some clinicians and researchers may favor establishing a clear differentiation between these forms of RVO; others may prefer not to consider iRVO as a separate entity. Whatever the case, retinal ischemia in RVO confers a higher risk of visual loss and neovascular complications; thus, it should be determined as accurately as possible in patients with this disease and be considered in clinical and experimental studies. Most recently conducted clinical trials evaluating new treatments for macular edema secondary to RVO included none or only few patients with iRVO based on previous definitions (i.e., few patients with sizeable areas of retinal ischemia were recruited in these trials), and thus it is unclear whether the results observed in recruited patients could be extrapolated to those with retinal ischemia. There has been scant research aiming at developing and/or testing treatments for retinal ischemia, as well as to prevent new vessel formation as a result of RVO. We provide a detailed review of the knowledge gathered over the years on iRVO, from controversies on its definition and diagnosis to the understanding of its epidemiology, risk factors and pathogenesis, the structural and functional effects of this disease in the eye and its complications, natural history, and outcomes after treatment. In each section, the definition of iRVO used is given so, independently of whether iRVO is considered a separate clinical entity or a more severe end of the spectrum of RVO, the information will be useful to clinicians to determine patient's risk, guide therapeutic decisions, and counsel patients and for researchers to design future studies.     

视网膜分支静脉阻塞视网膜微血管改变的定量研究

【摘要】 目的 研究视网膜分支静脉阻塞（BRVO）患者视网膜微血管改变的特点。设计 病例对照研究。研究对象 河北省邯郸市眼科医院连续的BRVO患者58例,对照组为“邯郸眼病研究”中按匹配原则抽取的非BRVO者200例。方法 对被研究者的眼底彩色照片定性判读视网膜微血管局部改变;利用计算机辅助软件（IVAN software, Australia）定量测量视网膜微血管管径,比较两组间的差异。主要指标 视网膜微血管局部改变包括局部视网膜动脉缩窄（FAN）、视网膜动静脉交叉压迫征（AVN）和动脉反光增强（OPAC）。定量测量指标为视网膜中央动脉直径（CRAE）、视网膜中央静脉直径（CRVE）和视网膜动静脉比值（AVR）。结果 CRAE、CRVE、AVR在BRVO组和非BRVO组分别为（136.0±20.7） μm Vs. （152.0±19.3） μm（P=0.000）;（207.2±23.1） μm Vs. （235.3±29.7） μm（P=0.000）;（0.66±0.13） Vs. （0.65±0.06）（P=0.019）。经多因素校正后视网膜血管局部改变FAN、AVN和OPAC在两组间比较的相对危险度分别为5.65（95%CI=1.77~18.03）、3.42（95%CI=1.48~7.89）和3.44（95%CI=1.44~8.24）（P均<0.05）。结论 视网膜动、静脉直径在BRVO者比非BRVO者均变窄,视网膜血管的局部改变在BRVO者比非BRVO者显著,因此视网膜血管的定量、定性分析可作为BRVO的观察指标。（眼科,2012,21：239-243）