眼底荧光血管造影在黄斑分支静脉阻塞中的临床应用

Clinical use of fundus fluorescein angiography for macular branch retinal vein occlusion

目的观察视网膜黄斑分支静脉阻塞(MBRVO)眼的阻塞面积大小、阻塞部位、黄斑中心凹毛细血管拱环破坏程度等因素,对视力预后的影响以及黄斑中心凹无血管区(FAZ)面积的改变。方法回顾分析检眼镜、荧光素眼底血管造影(FFA)检查确诊并经筛选的27例27只眼的临床资料,观察分析阻塞部位、黄斑中心凹毛细血管拱环破坏程度,并利用海德堡激光扫描眼底荧光造影系统的面积测量功能,对阻塞面积、FAZ面积及18名正常对照者FAZ面积的资料进行对比分析。结果27例MBRVO发生于黄斑上支者17只眼,占63%,平均阻塞面积为(16±10)mm2,平均视力0·32±0·28。黄斑下支者10只眼,占37%,平均阻塞面积为(12±10)mm2,平均视力0·37±0·20。在视力恢复和阻塞面积大小上,黄斑上支与下支两组间差异无统计学意义(P>0·05)。拱环破坏≥1/2和<1/2两组间视力比较差异有统计学意义(P<0·05),但面积比较差异无统计学意义(P>0·05)。27只眼阻塞面积平均值为(15±10)mm2,≥14·60mm2者10只眼,<14·60mm2者17只眼,两组视力比较差异无统计学意义(P>0·05)。MBRVO患者的FAZ面积明显大于正常人FAZ面积(P<0·05)。结论拱环破坏的范围是决定MBRVO预后视力的重要标准,而引流黄斑分支静脉阻塞后累计的病变范围对视力预后不起决定作用,MBRVO的FAZ面积比正常人的FAZ面积明显扩大。

Objective To observe the dimension and position of occlusion and the damage degree of capillary blood vessel arch in central foveal macula, and know their effects on prognosis of visual acuity and changes of foveal avascular area （FAZ）. Methods The data of 27 eyes of 27 patients with MBRVO diagnosed by ophthalmoscope and fluorescein angiography were retrospectively studied. The position of occlusion and damage degree of macular arch were observed and analyzed. The dimension of FAZ was measured with system of Heidelberg and was compared with 18 healthy subjects. Results In 27 patients, superior MBRVO occurred in 17 eyes （63 % ）, the average area of occlusion was （ 16 ± 10 ）mm^2, and the average visual acuity was 0.32 ± 0.28. Inferior MBRVO occurred in 10 eyes （37 % ）, the average area of occlusion was （ 12 ± 10） mm^2 ,and the average visual acuity was 0.37 ± 0.20. There was no significant difference in visual acuity and area of occlusion between the two types of patients. There was a significant difference in visual acuity between both groups whose damaged arch was larger than half of macular arch and less than half of macular arch （P〈 0.05 ）. There was no significant difference in area of FAZ between patients with MBRVO and healthy subjects （ P 〉 0.05 ）. The average areas of occlusion （ 15 ± 10 ） mm^2 oceured in 27 eyes, ≥ 14.60 mm^2 in 10 eye and ≤ 14.60 mm^2 in 7 eyes. There was no significant difference between both groups in wihich visual acuity was higher and lower than the average value （P 〉0.05 ）. The FAZ area in patients with MBRVO was obviously larger than FAZ area in healthy subjects. Conclusion The prognostic visual acuity of patients with MBRVO is determined by the scope of damaged macular arch. The area of occlusion is not the important factor. The area in FAZ of patients with MBRVO is obviously larger than that of healthy subjects.