低灌注视网膜病变荧光素眼底血管造影-27例临床分析

目的 观察头颈部周围血管狭窄、闭锁所致低灌注视网膜病变的荧光素眼底血管造影（FFA）特征. 方法 回顾分析我院血管外科经动脉数字减影血管造影仪行数字减影动脉造影（DSA）、头颈部周围血管多普勒及血管搏动检查确诊的头颈部周围血管狭窄、闭锁患者27例常规FFA检查资料. 结果 全部患者臂-网膜循环时间延长，最短20．0s，最长81.08 s，平均32.1 s。视网膜动静脉充盈时间差延长，最短6.0 s最长64.0 s,平均24.2 s。其中单纯臂-视网膜循环时间延长，动静脉充盈时间差延长10例,占37.0％；伴有微血管瘤、血管壁着染、毛细血管无灌注区11例，占40.7％；合并眼前部缺血综合征者6例，占22.2%。合并眼前部缺血综合征的6例患者中4例出现视网膜动脉变细，血流呈节段样改变及小血管闭锁或动静脉血管异常吻合；2例同时可见粗大血管袢。 结论 低灌注视网膜病变患者的FFA改变以视网膜灌注不良及视网膜缺血改变为主，其改变程度与颈动脉狭窄、闭锁程度及病程有关。严重供血不足可伴有眼前部缺血综合征. （中华眼底病杂志，2004，20：84-86）

Clinical analysis of fundus fluorescein angiography in 27 cases of low-perfused retinopathy

Objective To observe and analysis the features of images of fundus fluorescein angriography (FFA) in low-perfused retinopathy caused by cephalo-cervical peripheral vascular stenosis or occlusion. Methods The results of FFA of 27 patients diagnosed with carotid artery stenosis or occlusion by digital subtraction angiography (DSA) and examination of Doppler and vascular-pulsation were retrospectively analyzed. Result All of the patients had a delayed arm-retinal circulation duration from 20.0 to 81.08 seconds with the mean of 32.1 seconds; a delayed retinal arteriovenous filling duration from 6 to 64.0 seconds with the mean of 24.2 seconds. Delayed arm-retinal circulation duration and retinal arteriovenous filling duration in 10 cases (37.0%); microangioma, vascular wall staining, nonperfused capillary area in 11 (40.7%); and anterior ischemic syndrome in 6 (22.2%) were found. In the 6 patients with anterior ischemic syndrome, 4 cases had narrow retinal artery, segmental changes of blood stream, vascular atresia, and abnormal arterio-venous anastomosis, and 2 cases had bold vascular loops. Conclusions The main manifestations of FFA in patients with low-perfused retinopathy are malperfusion and retinal ischemia, whose degrees relate to the extend of carotid artery stenosis or atresia, and the process of the disease.Serious retinal ischemia may combined with anterior ischemic syndrome.