联合疗法治疗缺血型视网膜中央静脉阻塞的临床疗效评价  

A cinical study of combined therapy for ischemic central retinal vein occlusion

作　　者：刘丽娅[1] 马景学[1] 李素芬[1] 陈桂芬[1] 王蔷 高彦军[1] 

机构地区：[1]河北医科大学第二医院眼科,石家庄050000 [2]武警河北总队医院眼科

出　　处：《中国实用眼科杂志》2009年第3期260-265,共6页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价联合疗法即全视网膜光凝（PRP）、玻璃体切除术（PPV）、放射状视神经切开术（RON）及玻璃体内注射曲安奈德（IVTA）治疗缺血型视网膜中央静脉阻塞（CRVO）的临床疗效，探讨其作用机制及安全性。方法入选38例38只眼分为：第1组14只眼，术式为PRP、PPV、RON和IVTA2mg；第2组13只眼，术式为PRP、PPV、RON和IVTA4mg：第3组11只眼，术式为PRP、RON和IVTA4mg。术后平均随访≥6个月。手术前后观察最佳矫正视力、眼压、荧光眼底血管造影（FFA）及光相干断层扫描（OCT）等。结果随访最终34只眼（89．47％）最佳矫正视力较术前提高，术后3d、1、3、6个月及最终视力与术前相比均明显提高（P〈O．05）。FFA示术后1、3、6个月臂一视网膜循环时间及视网膜循环时间均较术前明显缩短（P〈0．01）。术后黄斑中心凹厚度、多焦视网膜电图（mfERG）及黄斑区视野均较术前明显改善（P〈0．01）。术中及术后并发症少见。结论联合疗法可改善缺血型CRVO患者视功能，减轻黄斑水肿，还可显著减少单纯IVTA引起的并发症。Objective This study was designed to assess the clinical effect of combined therapy, which included panretinal photocoagulation （PRP）, pars plana vitrectomy （PPV）, radial optic neurotomy （ RON ）and intravitreal Triamcinolone Acetonide （ IVTA ）for ischemic central retinal vein occlusion （ CRVO ） And the mechanism and safety of combined therapy were also discussed in the study.Methods 38 eyes of 38 patiems met the selection criteria were enrolled in the study, and were divided into three groups.Group 1 （ 14 eyes of 14 patients）received PRP,PPV,RON and IVTA 2rag.Group 2 （ 13 eyes of 13 patients ）received PRP, PPV, RON and IVTA 4rag.Group 3 （ 11 eyes of 11 patients ）received PRP, RON and IVTA 4mg.The average follow-up was longer than 6 months.The major observed criteria before and after treatment included best cor- rect visual acuity,intraocular pressure,fimdus fluorescein angiography （FFA）,optical coherence tomography （ OCT ）and so on.Results At the end of follow-up, best correct visual acuity improved in 34 eyes （ 89.47% ）. The best correct visual acuity at 3 day, 1,3,6 months and last visit were much better than pretreatment （P〈0. 05 ）.The results of FFA show that arm-retinal circulation time and retinal circulation time at 1,3,6 months were significantly shorter than pretreatment （P〈0.01）.OCT show that the central macular thickness was significantly decreased postoperatively（ P〈0.01 ）.Multifocal electroretinogram（ mfERG ）and primetry threshold of central 30 degree also show obvious improvement postoperatively （P〈0.01）.Complications were rare during and after the operation.Conclusions Combined therapy could significantly alleviate macular edema and improve the visual function for patients ofischemic CRVO.It could also reduce the complications of IVTA significantly.

关 键 词：视网膜中央静脉阻塞 放射状视神经切开术 曲安奈德 

分 类 号：R779.63[医药卫生—眼科] R253[医药卫生—临床医学]