视乳头切开术治疗视网膜中央静脉阻塞12例报告

Radial optic neurotomy for 12 case of central retinal vein occlusion

目的:探讨视乳头切开术治疗缺血性视网膜中央静脉阻塞的临床疗效。方法:缺血性视网膜中央静脉阻塞患者12例。术前患者均行眼底照相、荧光素眼底血管造影(FFA)检查。手术常规做玻璃体切割,应用显微玻璃体视网膜切开刀,以鼻侧视乳头边缘为中心,垂直刺入达最宽处为止。术后1,3,6mo行眼底照像、FFA检查。结果:术中,视乳头切开后均可见视盘近端视网膜静脉充盈增加,9例术中穿刺时有少量出血,未经特殊处理均很快停止,1例术中发生局限性视网膜下出血。术后1mo内,11例患者视网膜或黄斑水肿均减轻或消退。术后3mo,患者行眼底照像、FFA检查结果均显示视网膜出血吸收,黄斑水肿消退;10例视力较术前提高(80%)。1例保持不变,1例术中发生局限性视网膜下出血者术后视力下降。结论:视乳头切开术是安全有效的手术,有助于视网膜内出血、渗出及黄斑水肿的消退,部分患者视力可得到改善。

AIM： To investigate the surgical effect of radial optic neurotomy for ischemic central retinal vein occlusion （CRVO）. METHODS： Twelve consecutive patients （12 eyes）, preoperative examination including color fundus photography, fundus fluorescein angiography, underwent parplana itrectomy, A microvitreoretinal （MVR） blade was used to relax the scleral ring and adjacent sclera of nasal aside of the optic disk, The depth of the incision into the optic nerve placed the IVlVR blade just beyond the widest portion of the diamond-shaped tip. The follow-up period was 1, 3, 6 months, and postoperative examination including color fundus photography, fundus fluorascein angiography were performed. RESULTS： Radial optic neurotomy was performed in all 12 patients successfully. The retinal vein permeation increased were found after optic neurotomy in all patients , and the small hemorrhage in 9 patients, subretinal local hemorrhage in 1 patient was noted during the surgical procedure, and 11 patients had improve in the retina and macular edema and the appearance of the fundus in 1 month postoperatively and the retinal hemorrhage was significantly absorbed and macular edema disappeared in 3 months postoperatively as documented by photography , fluorescein angiography. Postoprative visual acuities were improved in 10 of 1.2 of patients （80%） and the visual acuities were not improved in 1 patient and the visual acuities were decreased in 1 patient with subretinal local hemorrhage. CONCLUSION： Radial optic neurotomy is a safe and effective operation and may improve the retinal hemorrhage, retinal exude, macular edema and the visual acuity prognosis in patients with ischemic CRVO.