新生血管性青光眼的临床和病理观察  

The clinical and pathological observations of neovascular glaucoma

作　　者：张惠蓉[1] 王 薇[1] 

机构地区：[1]北京医科大学第三医院眼科,100083

出　　处：《眼科研究》2002年第4期319-322,共4页Chinese Ophthalmic Research

摘　　要：目的 观察视网膜静脉阻塞所致新生血管性青光眼（NVG）的危险因素、视力预后和病理改变。方法（1）观察视网膜静脉阻塞429例445眼,其中总干阻塞369例385眼;半侧阻塞60例60眼。分析新生血管性青光眼的发病率、危险因素和视力预后。（2）视网膜消化铺片和病理切片光镜观察。结果445眼中36眼产生了 NVG,占8.09％;总于阻塞为9.09％,半侧阻塞为1.7％。产生NVG者均为缺血型。发生 NVG的危险因素有:（1）初诊视力低于0.1,眼底出血多。（2）高血压、冠心病、心动过缓者;血液流变性异常者;其中两项以上异常者22例占68.8％。（3）有原发性青光眼者,视网膜动脉硬化、视网膜动脉很细者。4例双眼发病者均有3项以上指标异常。追踪视力为无光感至数指者24眼,占66.7％;0.02～0.05者9眼,占25.0％,0.1～0.4者3眼,占8.3％。致盲率91.7％。消化铺片发现视网膜毛细血管内皮细胞增生形成实心细胞团及多量新生血管芽和形成管腔的新生血管。病理切片发现视盘有青光眼凹陷,静脉血栓形成,视网膜下蛋白液等。结论 初诊视力低下、缺血型视网膜静脉阻塞、原发性青光眼、高血压、动脉硬化、血黏度增高是视网膜静脉阻塞产生NVG的危险因素。NVG视力预后差,致盲率高。Objective To observe the clinical and pathological changes of neovascular glaucoma ( NVG) subsequent to retinal vein occlusion. Methods 445 eyes of 429 cases of retinal vein occlusion were examined, including 385 eyes of 369 cases with central retinal vein occlusion (CRVO) and 60 eyes in 60 cases of hemicentral retinal vein occlusion (H-CRVO). Among them,ischemic type with 295 eyes,nonischemic type with 150 eyes. Fluorescein angiography,trypsin digestion techniques and microscopic examination were used to study neovascularization and pathological changes in NVG. Also, the incidence, risk factors and visual prognosis of NVG were analyzed. Results 1. 36 eyes of 445 eyes with retinal vein occlusion developed NVG, the incidence was 8. 09%. CRVO 35 eyes (9. 09% ), H-CRVO 1 eye (1.7%),36 eyes with NVG were ishchemic type. Out of 32 cases with NVG,male 24,female 8,the average age 43. 0 years. Patients were followed-up from 3 to 240 months. The average follow-up period were 31. 6 months. 2. The risk factors of NVG; (1 )the initial acuity was an important factor. The initial acuity was lower than 0. 1 in 63.9% with NVG and 27.5% in non-NVG (P < 0. 001 ). (2 ) Systemic factors: hypertension, coronary cardiac diseases 65. 5% , hyperviscosity 46. 9% . ( 3 ) Eye diaseses; primary glaucoma 12. 5% , retinal arteriosclerosis 40. 6% .narrow retinal arteries 68. 8% . 3. Visual prognosis; the final visual acuity was poor in NVG from light perception to count finger 24 eyes (66. 7% ) ; 0. 02 - 0. 05 in 9 eyes (25. 0% ) , 0. 1 - 0. 4 in 3 eyes (8. 3% ) ; the rate of blindness was 91. 7% .4. Pathological findings; the newly formed vessels originated from retinal capillaries. The endothelial cells proliferated by budding to form a solid mass at first, and developed new vessels with lumen. The new vessels grew in retinal posterior pole and equator. Conclusions The risk factors for NVG are initial acuity, primary glaucoma, ischemia, hypertension and hyper-viscosity. The visual prognosis is poor, and the rate of blindness is high.

关 键 词：新生血管性青光眼 视网膜静脉阻塞 危险因素 预后 消化铺片 NVG 

分 类 号：R775[医药卫生—眼科]