基于眼卒中绿色通道的眼动脉内介入溶栓治疗视网膜动脉阻塞的有效性和安全性研究  

Efficacy and safety of intra-arterial thrombolysis for retinal artery occlusion based on the green channel for eye stroke

作　　者：梁安怡 牛勇毅[1] 吴乔伟 陈岱瑜 林宏彬 谭明奎 胡一骏 余洪华[1] Liang Anyi;Niu Yongyi;Wu Qiaowei;Chen Daiyu;Lin Hongbin;Tan Mingkui;Hu Yijun;Yu Honghua(Guangdong Eye Institute,Department of Ophthalmology,Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;School of Software Engineering,South China University of Technology,Guangzhou 510006,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)眼科,广州510080 [2]华南理工大学软件学院,广州510006

出　　处：《中华眼底病杂志》2023年第6期444-450,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金面上项目(82171075);广州市重点研发计划(202206010092)。

摘　　要：目的观察基于眼卒中中心绿色通道的超选择眼动脉内溶栓(IAT)治疗视网膜动脉阻塞(RAO)的早期疗效和安全性。方法前瞻性、干预性、单中心临床研究。2021年7月至2022年10月于广东省人民医院眼科接受IAT治疗的RAO患者38例38只眼纳入研究。所有患者均由眼卒中中心绿色通道入院。采用Snellen视力表检测患者最佳矫正视力(BCVA),统计时换算为最小分辨角对数(logMAR)视力;采用光相干断层扫描血管成像(OCTA)检查测量患者双眼黄斑中心凹视网膜浅层毛细血管丛(SCP)、深层毛细血管丛(DCP)、视盘周围毛细血管网(RPC)血流密度和中心凹视网膜厚度(CRT)。患眼中,成功行IAT治疗34只眼;因患眼同侧颈动脉或颈内动脉完全闭塞,导管无法上行插入眼动脉,未能成功行IAT治疗4只眼。治疗后1~3 d采用治疗前相同设备和方法行相关检查。对比观察治疗前后患眼BCVA以及SCP、DCP、RPC血流密度和CRT的变化。记录绿色通道救治相关指标:发病至首诊医院(发病-首诊医院)时长、发病至眼卒中中心(发病-眼卒中中心)时长。患眼与对侧健康眼治疗前血流密度、CRT比较采用独立样本Mann-Whitney U检验;患眼IAT治疗前后BCVA、血流密度、CRT比较采用配对样本Wilcoxon秩和检验。结果成功行IAT治疗的34例34只眼中,男性18例(52.9%,18/34),女性16例(47.1%,16/34);年龄(51.0±12.9)岁。视网膜中央动脉阻塞、视网膜分支动脉阻塞分别为30、4只眼。治疗前、后,患眼logMAR BCVA分别为2.52±0.61、2.18±0.85;治疗前后logMAR BCVA比较,差异有统计学意义(Z=-3.453,P=0.002)。治疗前,与对侧健康眼比较,患眼SCP、DCP、RPC血流密度明显降低,CRT明显升高,差异均有统计学意义(P<0.001)。与治疗前比较,患眼SCP、DCP血流密度明显提高,差异有统计学意义(Z=-2.523、-2.427,P=0.010、0.014);RPC血流密度、CRT差异无统计学意义(Z=-1.448、-1.454,P=0.150、0.159)。患者发病-首诊医Objective To explore the short-term efficacy and safety of intra-arterial thrombolysis(IAT)in the treatment of retinal artery occlusion(RAO)with the assistance of the rescue green channel in the eye stroke center.Methods A prospective,interventional,single-center study.Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled.All the patients were rescued via the green channel in our eye stroke center.Data from comprehensive ocular examinations including best-corrected visual acuity(BCVA)and optical coherence tomography angiography(OCTA)were collected.BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution(logMAR)unit for statistical analysis.RTVue XR OCTA was used to measure vascular densities(VD)of the superficial capillary plexus(SCP),deep capillary plexus(DCP)and radial peripapillary capillary(RPC),and central retinal thickness(CRT).All RAO eyes attempted IAT treatment and 34 eyes were successful.Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes.Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery.Parameters measured before and after surgery include BCVA,VD of SCP,DCP,RPC,and CRT.Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals,and from onset of RAO to our eye stroke center.Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test;comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test.Results Among the 34 RAO patients who had successful IAT surgery,18(52.9%,18/34)were males and 16(47.1%,16/34)were females;the mean age was(51.0±12.9)years old.There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively.The logMAR BCVA bef

关 键 词：视网膜动脉阻塞 眼动脉内介入溶栓 绿色通道 疗效 安全性 

分 类 号：R774.1[医药卫生—眼科]