激光诱导脉络膜视网膜静脉吻合术的临床研究  

Clinical study of laser-induced chorioretinal venous anastomosis

作　　者：卢宁[1] 李志辉[1] 王光璐[1] 张风[1] 彭晓燕[1] 

机构地区：[1]首都医科大学北京同仁眼科中心,100730

出　　处：《中华眼科杂志》2004年第1期20-25,共6页Chinese Journal of Ophthalmology

摘　　要：目的　探讨激光诱导脉络膜视网膜静脉吻合 (CRVA)术治疗非缺血型视网膜中央静脉阻塞的临床效果和安全性。方法　选择非缺血型视网膜中央静脉阻塞患者 3 4例 (3 5只眼 ) ,在实施一系列并发症预防措施的基础上进行激光诱导CRVA术治疗。治疗前、后常规检测患者视力和眼底情况 ,并行荧光素眼底血管造影检查。术后患者随访 3～ 12个月 ,平均 6个月。结果　共有 2 8只眼(80 % )CRVA术成功。治疗后 1～ 2个月 ,视网膜出血基本吸收 ,水肿改善。其中 2 0只眼 (71% )视力提高 ,无视力下降者。与自然病程相比 ,患者眼底和视力预后明显改善 ,未发生严重并发症。 7例 (7只眼 )CRVA术未成功 ,其中 2例 (2只眼 )发生了严重的新生血管并发症。结论　激光诱导CRVA术是治疗非缺血型视网膜中央静脉阻塞的有效方法 ,在对并发症采取适当预防措施的基础上行CRVA术 ,可显著提高CRVA术的安全性 ,但并不能完全避免严重新生血管并发症的发生。 (中华眼科杂志 ,2 0 0 4,40 :2 0 2 5)Objective To test the effectiv eness and safety of laser-induced chorioretinal venous anastomosis in the treatment of nonischemic central retinal vein occlusion (CRVO), and also the effectiveness of the preventative measures for complications associated with the treatment. Methods Laser-induced chorioretinal venous anastomosis was performed on 34 cases, 35 eyes with nonischemic CRVO. During the treatment, preventative measures for complications were taken as follows: (1) Patients with total retinal papillary nonperfusion area of less than 5 DA were selected to receive the treatment. (2) Treatment sites must be at least 3 PD away from the optic disc and 4 PD away from the macula.(3) At most 2 argon laser shots were attempted over each treatment site, to avoid severe laser damage. (4) Scattered argon laser photocoagulation was done over the drainage area of the vein distal to the treatment site, in order to prevent neovascular complications in case distal vein occlusion occur. Results During the 3～12 months (average 6 months) follow-up, successful anastomosis formed in 28 eyes out of 35eyes (80%) with a mean of 2.4 attempts to create an anastomosis in each eye. With successful anastomosis, retinal hemorrhage started to be absorbed gradually 2 weeks after the treatment, and almost entirely absorbed 1～2 months later. Retinal edema also alleviated. Visual acuity improved in 20 out of 28 eyes (71%), and remianed unchanged in the rest of the patients with successful anastomosis. In comparison with the natural course of the disease, our treatment has improved both the visual prognosis and the retinal damage caused by the disease. No serious complications occurred in these patients with successful anastomosis. Anastomoasis failed to form in 7 cases(7 eyes), among which, 2 eyes developed serious neovascular complications. Conclusions CRVA treatment is effective in the treatment of non-ischaemic CRVO. With proper preventative measures for complications associated with the treatment, the safty of the treatment can be i

关 键 词：激光诱导 脉络膜视网膜静脉吻合术 外科治疗 非缺血型视网膜中央静脉阻塞 

分 类 号：R779.63[医药卫生—眼科]