人眼缺血型视网膜中央静脉阻塞组织病理学观察

Histopathological studies on the ischemic central retinal vein occlusion in human eyes

目的观察视网膜中央静脉阻塞（CRVO）的病理改变，为临床寻找有效的防治方法提供客观的依据。方法对11例11只眼缺血型CRVO标本进行组织病理学分析，重点观察视盘和视神经处视网膜中央静脉（CRV）和中央动脉（cRA）的改变。结果11只眼CRV在通过筛板区时管腔均变狭窄。其中，5只眼在筛板区和筛板后区CRV内可见机化血栓存在，6只眼在筛板区及其后区CRV内存在血栓机化再通管道，CRV管壁内皮增生，管腔狭窄。11只眼CRA均有明显的动脉硬化改变，管壁增厚，管腔变细；2只眼CRA在筛板区管壁内膜增生，管腔严重狭窄；筛板水平CRA无血栓形成。结论在缺血型CRVO发生中，CRV在筛板水平有血栓形成；血栓机化再通的时间及程度，可能决定了CRVO的转归与预后。CRV在巩膜管狭小间隙内受压迫是CRVO的发病机制。

Objective To observe the histopathological changes in human eyes with ischemic central retinal vein occlusion （CRVO）, and to provide objective basis for effective methods of prevention and treatment for （CRVO）. Methods Histopathological analysis was performed on the samples of 11 eyes in 11 patients with ischemic CRVO. The changes of central retinal veins （CRV） and central retinal arteries （CRA） were observed. Results The lumen of CRV became narrow when passed through the lamina cribrosa in 11 eyes, in which organized thrombus was found in the lamina cribrosa region and post lamina cribrosa region in 5 eyes, and organized thrombus re-unobstructed channels, endothelial proliferation and narrow lumen were found in 6 eyes. Arteriosclerosis of the CRA was observed in all of the 11 eyes with thick wall of the artery and narrow lumen. Proliferation of endothelium of wall of CRA and narrow lumen in the lamina cribrosa region was found in 2 eyes and no thrombus was found at the lamina cribrosa level. Conclusion During the course of ischemic CRVO, thrombus occurs in CRV at the level of lamina cribrosa. The prognosis of CRVO may lie on the time and degree the thrombosis re-opens. The mechanism of CRVO is that CRV is pressed in the narrow interspace of scleral channels of lamina cribrosa.