内界膜脱离对非动脉炎性视网膜中央动脉阻塞患眼视力的影响  

The effect of internal boundary membrane detachment on visual acuity in the affectedside of non-arteriotic central retinal artery occlusion

作　　者：雷涛 王润生 张博 马腾 王笑 安金金 王琨 王小堂 王勇 Lei Tao;Wang Runsheng;Zhang Bo;Ma Teng;Wang Xiao;An Jinjin;Wang Kun;Wang Xiaotang;Wang Yong(Department of Ophtalmology,Xi'an People's Hospital(Xi'an Fourth Hospital),Xi'an 710004,China)

机构地区：[1]西安市人民医院(西安市第四医院)眼科,西安710004

出　　处：《中华眼底病杂志》2024年第11期854-859,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察非动脉炎性视网膜中央动脉阻塞(NA-CRAO)伴内界膜脱离(ILMD)患眼的临床及影像特征,初步分析其与视力预后的关系。方法回顾性临床研究。2014年1月至2023年6月于西安市人民医院(西安市第四医院)眼科住院治疗的NA-CRAO患者88例88只眼纳入研究。所有患者均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)、荧光素眼底血管造影(FFA)检查。BCVA检查采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。应用OCT观察是否存在ILMD以及视网膜内层是否增厚、解剖分层是否消失。采用FFA记录臂-视网膜循环时间(A-Rct)、视网膜动脉主干-末梢充盈时间(FT),观察睫状体视网膜动脉、荧光素逆行充盈、棉绒斑、荧光素节状性充盈、黄斑区无灌注、毛细血管荧光素渗漏、视盘强荧光、脉络膜背景弱荧光等特征。根据是否伴有ILMD,将患者分为ILMD组、非ILMD组,均为44例44只眼。两组患者采用相同治疗方法进行治疗。治疗后随访时间30 d。对比观察两组患者临床、FFA特征以及治疗前后BCVA。组间比较采用t检验。结果ILMD组、非ILMD组患者中,男性、女性均分别为43、1例,男性占比明显高于女性。治疗前及治疗后,ILMD组、非ILMD组患眼logMAR BCVA分别为2.35±0.42、2.01±0.46和1.47±0.60、0.77±0.49;两组患眼治疗前及治疗后logMAR BCVA比较,差异均有统计学意义(t=8.025、12.358,P<0.001)。治疗前,与非ILMD组比较,ILMD组患眼A-Rct、FT更长,差异有统计学意义(t=3.052、3.385,P<0.05);治疗后,差异无统计学意义(t=1.040、1.447,P>0.05)。ILMD组伴有睫状视网膜动脉、棉绒斑的占比低于非ILMD组,但伴有睫状视网膜动脉的占比差异无统计学意义(χ^(2)=-0.961,P>0.05),伴有棉绒斑的占比差异有统计学意义(χ^(2)=-3.364,P<0.05)。与非ILMD组比较,ILMD组视网膜动脉荧光素逆行充盈(χ^(2)=-2.846)、节段性充盈(χ^(2)=-3.907)、黄斑区无灌注Objective To observe the clinical and imaging features of non-arteriotic central retinal artery occlusion(NA-CRAO)with internal boundary membrane detachment(ILMD),and to analyze its relationship with visual prognosis.Methods A retrospective clinical study.A total of 88 patients with NACRAO hospitalized in Department of Ophtalmology,Xi'an People's Hospital(Xi'an Fourth Hospital)from January 2014 to June 2023 were included in the study.Best corrected visual acuity(BCVA),optical coherence tomography(OCT)and fluorescein fundus angiography(FFA)were performed.The BCVA test used the international standard visual acuity chart,which was statistically converted to the logarithm of the minimum angle of resolution(logMAR)visual acuity.OCT observed the presence of ILMD and the thickening of the inner retina and the disappearance of anatomical stratification.FFA recorded arm-retinal circulation time(A-Rct)and retinal arterion-distal filling time (FT), and observed ciliary retinal artery, fluorescein retrograde filling, cottonspots, luciferin nodal filling, macular non-perfusion, capillary fluorescein leakage, optic disc strong fluorescence,choroidal background weak fluorescence and other characteristics. According to whether there was ILMD, thepatients were divided into ILMD group and non-ILMD group, with 44 cases and 44 eyes respectively. The twogroups received the same treatment. The follow-up time was 30 days after treatment. The clinical, FFAcharacteristics and BCVA before and after treatment were compared between the two groups. t-test was used forcomparison between groups. Results In ILMD group and non-ILMD group, there were 43 cases of male and 1case of female, respectively, and the proportion of male was significantly higher than that of female. Before andafter treatment, the logMAR BCVA of ILMD group and non-ILMD group were 2.35±0.42, 2.01±0.46,1.47±0.60, 0.77±0.49, respectively. There were significant differences in logMAR BCVA between the twogroups before and after treatment (t-8.025, 12.358;P<0.001). Before tre

关 键 词：内界膜脱离 非动脉炎性视网膜中央动脉阻塞 视力预后 视网膜缺血 荧光素眼底血管造影 体层摄影术 光学相干 

分 类 号：R774.1[医药卫生—眼科]