联合治疗对缺血型视网膜中央静脉阻塞患者视网膜血流的影响  

Effect of fundus laser combined with anisodine and triamcinolone acetonide on hemodynamics of retina in ischemiccentral retinal central vein occlusion

作　　者：韩崧[1] 齐越[1] 李栋军[1] 高丽琴[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2017年第4期267-270,共4页Ophthalmology in China

摘　　要：目的观察眼底激光、曲安奈德、复方樟柳碱联合治疗缺血型视网膜中央静脉阻塞患者的疗效及对视网膜血流的影响。设计前瞻性病例系列。研究对象北京同仁医院缺血型视网膜中央静脉阻塞患者90例(90眼)。方法所有患者均予以全视网膜激光光凝治疗,按随机数字表分为3组,每组各30眼,Ⅰ组予以曲安奈德40 mg眼周注射2次,Ⅱ组每日予复方樟柳碱注射液2 ml颞侧皮下注射30天,Ⅲ组予以曲安奈德与复方樟柳碱注射液联合治疗。治疗前、治疗1个月时测定矫正视力,相干光断层扫描(OCT)检查黄斑中心厚度(CMT),彩色多普勒超声检测视网膜中央动脉的血流动力学指标。主要指标视网膜中央动脉的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、阻力指数(RI),视网膜中央静脉的最大流速(Vmax)和最小流速(Vmin)。结果Ⅲ组治疗后视网膜中央动脉的PSV和EDV均明显高于Ⅰ组、Ⅱ组(均P<0.05),RI明显低于Ⅰ组、Ⅱ组(均P<0.05),视网膜中央静脉的Vmax和Vmin均明显高于Ⅰ组、Ⅱ组(均P<0.05)。Ⅲ组视力改善有效率明显高于Ⅰ组、Ⅱ组(均P<0.05),CMT明显低于Ⅰ组、Ⅱ组(均P<0.05)。结论眼底激光、曲安奈德、复方樟柳碱联合治疗能有效改善缺血型视网膜中央静脉阻塞患者中央血管的血流动力学,优化治疗效果。Objective To observe the effect of fundus laser combined with anisodine and triamcinolone acetonide on hemodynamics of retinain ischemic central retinal vein occlusion. Design Prospective cases series. Participants 90 patients（90 eyes） with ischemic central retinal vein occlusion from January 2014 to October 2015 in Tongren Hospital. Methods All the patients were randomly divided into group I, II, III, and treated with pan retinal laser photocoagulation（PRP） for 4 times, once a week. Group I was injected 1ml（40 mg） triamcinolone acetonide in ipsilateral eye for once every 2 weeks. Group II was treated with 2 ml compound anisodine hydrobromide injection in superficial temporal artery subcutaneous for 30 days, once daily. Group III was treated with both anisodine and triamcinolone acetonide. Before and after treatment of 30 days, the hemodynamic parameters of the central retinal artery were detected with color Doppler ultrasonography. The best corrected visual acuity（BCVA） was measured by EDTRS visual acuity chart and the central macular thickness（CMT） was examined with optical coherence tomography（OCT）. Main Outcome Measures The peak systolic velocity（PSV）, end diastolic velocity（EDV） and the resistance index（RI） of the central retinal artery（CRA）; maximum flow velocity（Vmax） and minimum flow velocity（Vmin） of the central retinal vein（CRV）. Results The PSV and EDV of CRA in Ⅲ group were significantly higher than those in groupⅠand group Ⅱ（P〈0.05）. The RI in group III was lower than in groupⅠand group Ⅱ（P〈0.05）. Vmax and Vmin of the CRV in group III were significantly higher than those in group Ⅰand group Ⅱ（all P〈0.05）. The effect of visual of group III was significantly higher than that of group I and group II（P〈0.05）. CMT in group III was significantly lower than that in group I and II（P〈0.05）. Conclusion Fundus laser combined with anisodine and triamcinolone acetonide can improve the hemodynamics of central retinal ve

关 键 词：缺血型视网膜静脉阻塞/治疗 视网膜血流动力学 

分 类 号：R774.1[医药卫生—眼科]