低灌注视网膜病变并发新生血管性青光眼的临床特征

目的 探讨颈内动脉狭窄引起的低灌注视网膜病变并发新生血管性青光眼的临床特征.方法 回顾性系列病例研究.收集18例(18只眼)颈内动脉狭窄引起的低灌注视网膜病变并发新生血管性青光眼患者的一般情况、视力、眼压、眼底改变、荧光素眼底血管造影、颈动脉超声多普勒、磁共振血管造影、数字减影血管造影等临床检查资料,进行回顾性分析,从中探寻低灌注视网膜病变并发新生血管性青光眼的临床特征.结果 18例低灌注视网膜病变并发新生血管性青光眼患者中,男性15例,女性3例;年龄18～78岁,平均40岁.患者就诊时视力为光感至0.8.眼压＞21 mm Hg(1 mm Hg=0.133 kPa)的有14只眼,眼压≤21 mm Hg的有4只眼.18只眼均可见虹膜、前房角新生血管.眼底检查:视网膜动脉细;静脉不规则扩张,但不扭曲;视网膜赤道部有点片状出血,可见微动脉瘤,后极部有棉絮状斑.影像学检杳均显示有颈内动脉狭窄和阻塞表现.结论 新生血管性青光眼是低灌注视网膜病变少见而严重的并发症.其眼底表现及青光眼体征具有特征性.眼底病变以单眼为主,视网膜静脉扩张,但不扭曲,出血主要在赤道部.大部分患眼眼压高,视盘有凹陷性萎缩,虹膜及前房角有新生血管,可见各种形态的视野缺损.

Clinical features of hypoperfusion retinopathy induced neovascular glaucoma

Objective To analyze the clinical features of hypoperfusion retinopathy induced neovascular glaucoma. Methods This retrospective case series included 18 cases (18 eyes) with hypoferfusion retinopathy induced neovascular glaucoma. Among them, there were 15 male and 3 female; 10 fight eye and 5 left eye. The average age was 40 year old ( ranged from 18 to 78 year old). Visual acuity and fundus were examined using fundus fluorescein angiography (FFA) , Color Doppler Flow Imaging (CDFI),magnetic resonance angiography (MRA), and Digital subtraction angiography (DSA)etc in all patients.Results The visual acuity was ranged from light perception to 0.8 in all patients. The clinical features in hypoperfusion retinopathy induced neovascular glaucoma were characterized by midperipheral intraretinal hemorrhages, narrowed retinal arteries, dilated retinal veins, neovascularisation in iris and anterior chamber angle, ocular hypertension, excavation and atrophy of optic disk, and visual field defects when glaucoma progressed. All eyes have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries. Conclusions Neovascular glaucoma is a rare and severe complication of hypoperfusion retinopathy associated with either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries. Fundus degeneration is commonly involved in one eye.The characteristic clinical features are presented during the process of the disease.