彩色多普勒超声在间接性视神经损伤诊断中的应用

间接性视神经损伤的发生原因有多种学说，视神经缺血学说近年来被广大学者认同。我们自1998年6月～2006年6月采用彩色多普勒超声（CDFI）检测36例视神经损伤患者眼部血流变化，现总结如下。     

间接性视神经损伤血流动力学改变与预后相关性

目的:探讨间接性视神经损伤患者眼血流动力学变化规律与预后的相关性。方法:应用彩色多普勒血流成像(CDFI)技术检测102例患者视网膜中央动脉、睫状后动脉、眼动脉收缩峰值速度(PSV)、舒张末期流速(EDV)、时间平均最大血流速度(TAMX)、阻力指数(RI),并对视力与血流改变、血流改变与预后的关系进行观察。结果:患者102例中,95例患者眼动脉、睫状后动脉PSV明显增加(P<0.05),EDV明显减低(P<0.05)、TAMX减低(P<0.05)、RI显著增高(P<0.01);102例患者视网膜中央动脉血流参数无显著差异(P>0.05)。视力越差,血流改变越明显,预后越差。结论:间接性视神经损伤患者眼动脉、睫状后动脉呈高速高阻血流动力学改变、血流改变越明显预后越差。     

彩色多普勒在脉络膜血管瘤诊断中的应用

目的 探讨彩色多普勒成像（color Doppler imaging,CDI）技术对脉络膜血管瘤瘤的诊断价值.方法 用CDI及CT对4例脉络膜血管瘤做影像分析.结果 4例脉络膜血管瘤显示肿瘤内呈“血管池”样充盈或弥散星、点分布的丰富血流,频谱含呈较低阻力动脉血流和静脉血流波形.结论 用CDI分析脉络膜肿瘤血流特征有助于其鉴别诊断.     

彩色多普勒成像在糖尿病视网膜病变患者中的应用价值

目的：探讨彩色多普勒成像在糖尿病视网膜病变(DR)患者中的应用价值。

方法：选取2015-05/2017-05在我院就诊的2型糖尿病患者103例103眼,其中无糖尿病视网膜病变(NDR)患者32例32眼,非增殖性糖尿病视网膜病变(NPDR)患者40例40眼,增殖性糖尿病视网膜病变(PDR)患者31例31眼,同时选取健康志愿者40例40眼作为正常对照组,采用彩色多普勒超声检查各组视网膜中央动脉(CRA)、睫状后动脉(PCA)、眼动脉(OA)的最大收缩期血流速度(PSV)、舒张末期血流速度(EDV)和阻力指数(RI)。

结果：各组CRA、PCA和OA的PSV、EDV和RI比较差异有统计学意义(P<0.05); NDR组CRA、PCA、OA的PSV分别为12.38±2.10、13.36±2.55和32.04±6.07cm/s,明显高于NPDR组(9.70±1.67、12.20±2.01、27.40±4.32cm/s)和PDR组(7.13±1.40、10.31±1.82和22.10±3.51cm/s),差异有统计学意义(P<0.05),EDV分别为4.67±1.20、5.61±1.25和8.40±1.51cm/s,明显高于NPDR组(3.52±1.19、5.01±1.30和6.61±1.67cm/s)和PDR组(2.48±1.02、4.11±1.04和4.01±1.52cm/s),差异有统计学意义(P<0.05),而RI分别为0.63±0.07、0.60±0.04和0.77±0.05),明显低于NPDR组(0.72±0.06、0.67±0.05和0.81±0.03)和PDR组(0.80±0.09、0.74±0.06和0.86±0.04),差异有统计学意义(P<0.05)。

结论：彩色多普勒成像监测糖尿病眼部血管血流动力学变化,可为早期发现糖尿病视网膜病变提供依据。     

Orbital color Doppler imaging of optic nerve tumors

Objective: To report changes in retinal arterial and venous blood flow pattern in two patients with tumors involving the entire optic nerve. Methods: Retrospective review of one patient with clinical and neuroimaging characteristics typical of bilateral optic nerve gliomas and one patient with a probable meningioma of the left optic nerve sheath. Results: The optic nerve glioma patient had reduced peak systolic velocity of central retinal arteries bilaterally, while the patient with an optic nerve sheath meningioma had relatively low central retinal artery flow velocity and intermittent blood flow in the central retinal vein on the affected side. Conclusions: Reduced retinal arterial flowvelocities in the setting of optic nerve gliomas may correlate with thepresence of optic nerve disease. Phasic blood flow in the central retinalvein with optic nerve sheath meningioma may be the reason that somepatients with this tumor develop retinal choroidal venous anastomoses.     

高频彩色多普勒超声在严重眼外伤中的应用

目的评价应用彩色多普勒超声提高严重眼外伤的诊断水平。方法对30例（30眼）严重眼外伤患眼二维超声图像上表现较混乱的眼内病理膜、眼眶组织结构通过高频彩色多普勒显像（CDFI）,清楚显示出视网膜、脉络膜及机化膜的血流情况。结果 30例（30眼）严重眼外伤检出视网膜脱离、脉络膜脱离8眼,占26.67%,合并视网膜脱离、脉络膜脱离、眶内血肿3眼,占10.00%;合并视网膜脱离、脉络膜脱离、眼部异物13眼,占43.33%（眼内异物10眼,眶内异物3眼）;合并出血性脉络膜脱离5眼,占16.67%;眼眶血管异常（颈动脉海绵窦瘘1眼,占3.33%。经手术证实,符合率（28/30）93.33%。结论高频彩色多普勒超声可显著提高严重眼外伤的诊断水平,并有效地指导临床治疗。     

颅外伤合并间接性视神经损伤

目的 探讨颅外伤合并间接性视神经损伤的临床诊断和治疗。方法 回顾分析了颅外伤合并间接性视神经损伤36例（36眼）的临床资料。11例行视神经减压术，25例接受药物治疗。结果 全部患者伤侧眼的相对瞳孔传入障碍（RAPD）阳性；眼眶CT扫描显示有眶壁和／或鼻窦骨折。药物治疗组有8例（32．00％）视力提高1行，其余17例（68．00％）视力无改善，手术治疗组有1例（909％）由数指／1．5m提高到03，5例（45．46％）恢复了瞳孔直接对光反应，1例（9．09％）恢复了VEP波，其余4例（36．36％）视力无改善。结论 对颅外伤患者应进行RAPD检查及眼眶CT扫描，确定有无间接性视神经损伤。皮质类固醇和视神经减压联合应用可能更有利于视功能的恢复。     

应用彩色多普勒血流成像技术对后部缺血性视神经病变的研究

目的:探讨后部缺血性视神经病变(posterior ischenic optic neuropathy,PION)患者颈动脉及眼血流动力学的改变。方法:应用彩色多普勒血流成像技术(color Doppler flow imaging,CDFI)观察14例19眼PION患者,检测颈总动脉和颈内动脉影像学特征、睫状后动脉(posterior ciliary arteries,PCAs)和视网膜中央动脉(central retinal artery,CRA)血流动力学变化,与患者未受累一侧眼进行比较。结果:14例PION患者中12例(86%)表现为双侧颈总动脉和颈内动脉内膜粗糙、增厚,9例(64%)探查到血管壁斑块回声,硬斑5例,混合斑5例,软斑3例;PCAs的收缩期峰值速度(peaksy stolic velocity,PSV)为27.60±16.7cm/s,阻力指数(resistance index,RI)为0.84±0.038,与对照眼比较PSV无显著降低,RI明显增高(t=2.116,P<0.05);CRA的PSV为11.51±3.47cm/s,RI为0.75±0.036,与对照眼比较PSV无差异,RI增高非常明显(t=2.862,P<0.01)。结论:PION的发生主要与颈动脉粥样硬化导致的颈动脉系统血流变化有关,CDFI对明确PION诊断有重要的应用价值。     

应用彩色多普勒血流显像检测眼前部缺血性视神经病变

应用彩色多普勒血流显像检测眼前部缺血性视神经病变,以探讨其血流动力学变化特征。     

彩色多普勒超声在早产儿视网膜病变中应用

目的 观察5期早产儿视网膜病变的超声显像特征.方法 用彩色多普勒超声诊断仪检查80例(150只眼)于眼科临床检查发现异常的早产患儿,并观察彩色多普勒血流成像(CDFI)形态特点及病变的血流特征.结果 在早产儿患眼超声检查80例(150只眼)眼内显示为与晶状体回声紧密相连并包绕其周围的不规则光团回声,光团与视乳头间条索状...     

Multiple sclerosis and optic nerve: an analysis of retinal nerve fiber layer thickness and color Doppler imaging parameters

Purpose

To compare both retinal nerve fiber layer thickness and orbital color Doppler ultrasonography parameters in patients with multiple sclerosis (MS) versus healthy controls.

Methods

This is an observational case–control study. Forty eyes from MS patients and twenty eyes from healthy volunteers were examined. Eyes were classified into three groups as group 1, eyes from MS patients with previous optic neuritis (n=20); group 2, eyes from MS patients without previous optic neuritis (n=20); and group 3, eyes from healthy controls (n=20). Following complete ophthalmologic examination and retinal nerve fiber layer thickness measurement for each group, blood flow velocities of posterior ciliary arteries, central retinal artery, ophthalmic artery, and superior ophthalmic vein were measured. Pourcelot index (resistive index), an indicator of peripheral vascular resistance, was also calculated. The statistical assessment was performed with the assistance of Pearson''s Chi-square test, Mann–Whitney U-test, Kruskal–Wallis test, and Spearman''s correlation test.

Results

The studied eyes exposed similar values in terms of intraocular pressure and central corneal thickness, implying no evidence in favor of glaucoma. All nerve fiber layer thickness values, except superior nasal quadrants, in group 1 were found to be significantly thinner than groups 2 and 3. Blood flow velocity and mean resistivity index parameters were similar in all the groups.

Conclusions

In MS patients, especially with previous optic neuritis, diminished retinal nerve fiber layer thickness was observed. Contrary to several studies in the current literature, no evidence supporting potential vascular origin of ocular involvement in MS was found.     

Evidence of orbital deformation in indirect optic nerve injury. Weight lifter's optic neuropathy

A 16-year-old boy developed monocular visual loss due to optic neuropathy following frontal head trauma. His trauma was unique in that it consisted of a static loading force to the brow, rather than the dynamic impact more commonly associated with blunt orbital injuries. This case demonstrates the role of isolated deformation of orbital bones in the pathogenesis of indirect optic nerve injury.     

彩色多普勒超声在玻璃体积血诊断中的应用

目的:评价高频彩色多普勒超声(color doppler flow imaging,CDFI)在辅助玻璃体积血（vitreous hemorrhage, VH）术前病因诊断中的应用价值。 方法:对20例20眼二维超声图像上表现VH的患眼,通过CDFI和眼底及既往病史进行术前诊断。所有患者均行玻璃体切割手术,结合术中所见和术后荧光素血管造影、吲哚青绿造影进行术后诊断。 结果：VH患眼20例20眼CDFI检出视网膜脱离5例（25%）,视网膜脱离合并脉络膜脱离2眼（10%）,视网膜下出血2眼（10%）。经手术证实,增殖性糖尿病视网膜病变7例（35%）,视网膜中央/分支静脉阻塞7例（35%）,孔源性视网膜脱离3例（15%）,年龄相关性黄斑变性1例（5%）,息肉样脉络膜视网膜病变1例（5%）,Eales病1例（5%）。术前诊断和术后诊断符合率为95%(19/20)。 结论：高频CDFI可辅助VH术前病因判断,并有效地指导临床治疗。