选择性眼动脉溶栓治疗CRAO前后眼底荧光素血管造影的改变

Changes of fundus fluorescein angiography in patients with central retinal artery occlusion before and after treatment of selective ophthalmic artery thrombolysis

目的观察视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)采用选择性眼动脉溶栓治疗前后的荧光素眼底血管造影(fundus fluorescein angiography,FFA)表现,了解溶栓治疗对视网膜中央动脉血流灌注的改善情况。方法收集2006年2月至2009年5月在我科采取选择性眼动脉溶栓治疗CRAO患者,观察患者溶栓前后眼底情况并记录溶栓前、溶栓后48h、溶栓后1个月的荧光血管造影臂-视网膜动脉显影时间及视网膜动-静脉显影时间,并进行对比。结果本研究共收集CRAO患者24例,溶栓前臂-视网膜动脉显影时间平均为(28.87±6.85)s,溶栓后48h及1个月臂-视网膜动脉显影时间分别为(15.21±4.01)s及(15.71±3.43)s,与溶栓前对比显著缩短,差异均有显著统计学意义(均为P<0.001);溶栓前视网膜动-静脉显影时间平均为(40.17±8.55)s,溶栓后48h及1个月视网膜动-静脉显影时间分别为(22.25±4.73)s及(21.71±3.77)s,与溶栓前比较缩短,差异也均有显著统计学意义(均为P<0.001)。溶栓后1个月数字减影血管造影显示:视网膜内层水肿逐渐减轻,但视盘及视网膜神经纤维层出现不同程度萎缩。结论选择性介入溶栓治疗CRAO可及时有效恢复视网膜血供,缩短荧光造影的臂-视网膜动脉显影时间及视网膜动-静脉充盈时间,但即使迅速恢复了视网膜中央动脉血供,仍可会出现视网膜神经组织不同程度的组织形态学损害。

Objective To investigate the improvement of central retinal arterial perfusion with thrombolysis treatment by observing changes of fundus fluorescein angiography（FFA） in patients with central retinal artery occlusion（CRAO） before and after the treatment of selective ophthalmic artery thrombolysis.Methods A total of 24 CRAO patients were performed with selective ophthalmic artery thrombolysis in our department from February 2006 to May 2009.Eyeground situations were observed before and after thrombolysis in patients.FFA image,fluorescence opacification branch-retinal artery visualization time and retinal artery-vein visualization time were recorded and compared before thrombolysis,at 48 hours and 1 month after thrombolysis.Results Fluorescence opacification branch-retinal artery visualization time was（28.87±6.85） seconds before thrombolysis,and were（15.21±4.01） seconds and（15.71±3.43） seconds at 48 hours and 1 month after thrombolysis,which had statistical difference with that before thrombolysis（both P〈0.001）.The average retinal artery-vein visualization time was（40.17±8.55） seconds before thrombolysis,which were（22.25±4.73） seconds and（21.71±3.77） seconds at 48 hours and 1 month after thrombolysis,which had significant difference with that before thrombolysis（both P〈0.001）.At 1 month after thrombolysis,the fundus examination showed that retinal edema was gradually decreased,but optic disc and retinal nerve fiber layer were with various degrees of atrophy.Conclusion Selective intervention thrombolysis for CRAO can effectively and timely recover retinal blood supply,shorten fluorescence opacification branch-retinal artery visualization time and retinal artery-vein visualization time with FFA image.Even blood supply of central retinal artery is recovered quickly,retinal nerve tissues are with various degrees of histomorphological injury.