视网膜静脉阻塞合并视网膜动脉阻塞临床分析  

Clinical analysis of the retinal vein occlusion combined with retinal artery occlusion

作　　者：许梦涵 刘昊 郑雪晶 侯力华 李霞波 闫梅 李彤 鲁鑫 王敏[1] Xu Menghan;Liu Hao;Zheng Xuejing;Hou Lihua;Li Xiabo;Yan Mei;Li Tong;Lu Xin;Wang Min(Department of Ophthalmology,First People's Hospital of Xianyang City(Xianyang Eye Hospital),The First People's Hospital of Xianyang City Affiliated to Shaanxi University of Traditional Chinese Medicine,Clinical Medical Research Center of Eye Diseases Xianyang 712000,China)

机构地区：[1]陕西省咸阳市第一人民医院眼科(咸阳市眼科医院),陕西中医药大学附属咸阳市第一人民医院陕西省眼科疾病临床医学研究分中心,咸阳712000

出　　处：《中华眼底病杂志》2024年第11期848-853,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察视网膜静脉阻塞(RVO)合并视网膜动脉阻塞(RAO)患眼的临床及影像学特征。方法回顾性临床研究。2022年2月1日至2024年1月31日于咸阳市第一人民医院眼科检查确诊的RVO合并RAO伴黄斑水肿患者15例15只眼纳入研究。其中,视网膜分支静脉阻塞(BRVO)合并视网膜分支动脉阻塞(BRAO)3例3只眼;视网膜中央静脉阻塞(CRVO)合并视网膜中央动脉阻塞(CRAO)12例12只眼。所有患眼均行最佳矫正视力(BCVA)、眼压、扫描激光检眼镜、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)以及血清同型半胱氨酸检查。同时行OCT血管成像(OCTA)检查6只眼。所有患眼均行玻璃体腔注射抗血管内皮生长因子药物治疗。初始1次治疗后,经评估按需给药。治疗后每一个月随访1次,连续12个月。3个月时行FFA检查。随访时发现毛细血管出现无灌注区及时给予视网膜激光光凝治疗。回顾分析患眼眼底表现以及FFA、OCT、OCTA特征和发病原因。结果15例15只眼中,男性9例9只眼,女性6例6只眼;年龄(61.0±9.7)岁。均主诉单眼无痛性视力下降。所有患眼相对性传入性瞳孔障碍阳性。对侧眼先天性视盘缺损1例;高血压6例;高同型半胱氨酸血症2例;脑梗死3例;冠心病1例。CRVO合并CRAO 12只眼BCVA光感~0.25;BRVO合并BRAO 3只眼BCVA分别为0.1、0.4、0.25。所有患眼后极部视网膜水肿,静脉纡曲、扩张,动脉纤细,走形僵直;视网膜呈片状或“火焰状”出血。后极部视网膜棉绒斑13只眼。CRVO合并CRAO者12只眼,视盘水肿,边界欠清晰;BRVO合并BRAO者3只眼,视盘未见明显异常,边界清晰。FFA检查,动脉无充盈或充盈时间延长,视网膜静脉层流时间延迟,毛细血管充盈相对迟缓甚至不充盈,黄斑小动脉不同程度闭锁、拱环结构破坏,视盘毛细血管扩张、荧光素渗漏。OCT检查,视网膜中内层不同程度增厚、弥漫性反射增强,层间结构欠清晰,其下视网膜组�ObjectiveTo observe the clinical and imaging features of patients with retinal vein occlusion(RVO)complicated with retinal artery occlusion(RAO).Methods A retrospective clinical study.Fifteen patients with 15 eyes with RVO combined with RAO and macular edema diagnosed by ophthalmology examination in the Department of Ophthalmology,First People's Hospital of Xianyang City during 2 years from February 1,2022 to January 31,2024 were included in the study.Branch retinal vein occlusion(BRVO)combined with branch retinal artery occlusion(BRAO)occurred in 3 cases and 3 eyes.Central retinal vein occlusion(CRVO)complicated with central retinal artery occlusion(CRAO)in 12 eyes.Best corrected visual acuity(BCVA),intraocular pressure,scanning laser ophthalmoscope,optical coherence tomography(OCT),fluorescein fundus angiography(FFA)and serum homocysteine were all performed.OCT angiography(OCTA)was performed in 6 eyes. All eyes were treated with intravitreal injection of anti-vascular endothelial growthfactor drugs. After the initial 1 treatment, dosage was assessed as needed. Follow-up was performed every monthfor 12 months after treatment. FFA inspection was performed at 3 months. During follow-up, it was found thatthere were no perfusion areas of capillaries, and retinal laser photocoagulation therapy was given in time. Fundusmanifestations, FFA, OCT, OCTA characteristics and causes of disease were analyzed retrospectively. ResultsThere were 15 eyes in 15 cases, 9 eyes in 9 males;6 women with 6 eyes. Age was (61.0±9.7) years. Allcomplained of painless vision loss in one eye. All eyes were positive for relative afferent pupillary disorder.Contralateral congenital optic disc defect was in 1 case;hypertension was in 6 cases;hyperhomocysteinemia wasin 2 cases;cerebral infarction was in 3 cases;coronary heart disease was in 1 case. CRVO combined with CRAOwas in 12 eyes BCVA light sensitivity-0.25. The BCVA of BRVO combined with BRAO were 0.1, 0.4 and 0.25,respectively. All the patients had retinal edema in the posterior pole of

关 键 词：视网膜静脉闭塞 视网膜动脉闭塞 临床特征 治疗预后 

分 类 号：R774.1[医药卫生—眼科]