二步法激光诱导脉络膜视网膜静脉吻合术治疗兔视网膜中央静脉阻塞的疗效

Therapeutic effect of two-step laser-induced chorioretinal venous anastomosis on central retinal vein occlusion in rabbits

目的:评价二步法激光诱导脉络膜视网膜静脉吻合术(laser-inducedchorioretinalvenousanastomosis,LCRVA)治疗视网膜中央静脉阻塞(centralretinalveinocclusion,CRVO)的可行性及有效性。方法:青紫蓝兔22只44眼,光动力学方法建立兔双眼的CRVO模型。任选1眼作为治疗眼,先后用倍频Nd:YAG激光器和YAG激光器分别在选定部位击破Bruch膜及相邻的静脉壁,以建立视网膜静脉与脉络膜血管之间的吻合通道;另1眼作为对照。在治疗后4mo行眼底荧光素血管造影(fundusfluoresceinangiography,FFA)以及组织病理学检查,通过组间的对比来评价LCRVA治疗CRVO的疗效。结果:有34眼(77%,15只兔双眼,4只兔单眼)一次性建立了CRVO模型。对其中的17眼行LCR-VA,每眼击射2个点。经FFA证实,有8眼(47%)中的11个点(32%)存在功能性吻合。术后4mo,通过对各组的FFA及组织病理切片对比发现,吻合成功眼的视网膜病变严重程度明显比CRVO组轻。结论:二步法LCRVA治疗CRVO是可行及有效的,旁路引流通路的建立可以延缓CRVO病情的进展。

AIM： To evaluate the therapeutic effect of two-step laser-induced chorioretinal venous anastomosis （LCRVA） in the treatment of central retinal vein occlusion （CRVO）. METHODS： CRVO model was made by the photodynamic method in 22 rabbits （44 eyes）. After one eye of the rabbits was randomly selected, we used multiple-frequency Nd：YAG and YAG laser devices to rupture the Burch＇s membrane and the adjacent venous wall to build the anastomosis. Therapeutic effect was determined by the results of fundus fluorescein angiography （FFA） and histopathologic examination four months later. RESULTS： CRVO model was made successfully in 34 eyes （77.3%）, and 17 of them were treated with LCRVA at two different sites. The result of FFA revealed that the functional anastomosis was established in 8 eyes （47%, 11 sites） after 3-5wk. At postoperative 4too, comparing the results of FFA and histopathologic examination of different groups, the impairment to the retina in the group with anastomosis established was found to be slighter than that in the CRVO group. CONCLUSION： Two-step LCRVA is a feasible and effective way in treating CRVO, and the establishment of the by-pass drainage can postpone the progression of the disease.