40岁及以下人群视网膜中央静脉阻塞的研究

Clinical findings of central retinal vein occlusion in population aged 40 years or less

目的研究≤40岁视网膜中央静脉阻塞(CRVO)患者的临床表现及预后。方法对≤40岁的CRVO患者15例15眼的临床特征进行观察分析,对患眼治疗前后的最佳矫正视力和荧光素眼底血管造影(FFA)不同血管充盈期的臂-视网膜循环时间进行比较,此外对患者的临床表现,包括全身病史和相关的实验室检查进行分析。结果≤40岁的患者发生CRVO具有起病急、视力急剧下降、视网膜出血明显、治疗后患者视力提高显著的特点。患者治疗2个月后对数视力较治疗前明显改善(4.97±0.16vs3.56±0.14),差异有统计学意义(t=24.912,P<0.01)。FFA检查显示,动静脉期、静脉期以及静脉晚期的臂-视网膜循环时间治疗前分别为(21.68±2.97)s、(25.12±2.81)s和(28.13±4.37)s,治疗后分别为(13.51±1.87)s、(14.91±2.55)s和(19.10±3.02)s,治疗后较治疗前明显缩短,差异均有统计学意义(t=13.612、t=18.939、t=9.699,P<0.01)。≤40岁的CRVO患者的原发病包括高血压、糖尿病,精神紧张是主要的发病诱因。无严重并发症。结论≤40岁的CRVO患者挽救视力的关键在于早期发现和及时治疗。

Background The incidence of central retinal vein occlusion（CRVO） in young adult population is gradually increased with the higher occurrence of diabetic mellitus,hypertension,mental tension,etc..But ideal therapy could be obtained by prompt management.ObjectiveThis study was to further understand the clinical characteristics of CRVO in young adults.MethodsThis was a case-observatory study.Fifteen eyes of 15 cases aged 40 years or less with CRVO were collected in Beijing Chaoyang Hospital.The optimal visual acuity and fluorescine fundus angiography were compared between before treatment and after treatment.The clinical manifestations of CRVO patients,including the systemic disease history and laboratory examination results,were clinically analyzed.This clinical trial followed Helsinki Declaration.Oral informed consent was obtained from each subject prior to the medical process.ResultsThe characteristics of CRVO in young adult included the sudden onset,serious loss of visual acuity and massive retinal hemorrhage.The vision of patients at first visit was 3.56±0.14 and that at 2 months after treatment was 4.97±0.16,showing a statistically significant difference between them（t=24.912,P0.01）.FFA revealed that the time of arm-retina at arteriovenous phase,venous phase,late venous phase after treatment were considerably shortened in comparison with before treatment（13.51±1.87 vs 21.68±2.97 seconds,14.91±2.55 vs 25.12±2.81 seconds and 19.10±3.02 vs 28.13±4.37 seconds,respectively）（t=13.612,t=18.939,t=9.699,P0.01）.The systemic diseases in patients aged 40 years or less with CRVO included hypertension,diabetes mellitus and psychentonia.No complication of CRVO was found in this study.ConclusionCRVO in young adult aged 40 years or less can recover by prompt treatment.