视网膜中央动脉阻塞介入溶栓治疗前后视网膜组织形态学改变

Retinal morphological changes in central retinal artery occlusion after intra-arterial thrombolysis treatment

目的通过对视网膜中央动脉阻塞患者行选择性眼动脉溶栓治疗,观察治疗前后眼底彩照、荧光血管造影及黄斑OCT改变,了解溶栓前后视网膜组织形态学改变。方法收集在我科行选择性眼动脉溶栓治疗的视网膜中央动脉阻塞患者17例,溶栓前、溶栓后48h行眼底彩照、黄斑OCT及眼底荧光血管造影检查,记录溶栓前、溶栓后48h眼底荧光血管造影后臂-视网膜显影时间及视网膜动-静脉显影时间;术后1个月复查眼底彩照和OCT改变。结果患眼溶栓前及溶栓后48h,OCT显示黄斑明显增厚,黄斑中心凹平均厚度分别为(265.00±105.93)μm及(269.00±99.04)μm,与对侧健眼的(161.00±18.06)μm相比,差异有显著统计学意义(均为P<0.01);治疗后1个月黄斑变薄,黄斑中心凹平均厚度为(139.00±34.11)μm,与治疗前、治疗后48h及对侧健眼比较差异有统计学意义。眼底彩照显示,溶栓前视网膜中央动脉明显变细,后极部视网膜灰白色水肿,黄斑樱桃红;溶栓后48h视网膜中央动脉血流恢复,视网膜水肿仍同前;溶栓后1个月,视网膜水肿逐渐减轻,但视盘及视网膜神经纤维层出现不同程度萎缩。眼底荧光血管造影示溶栓前臂-视网膜动脉显影时间及视网膜动-静脉显影时间明显延长,分别为(30.65±7.11)s及(39.82±7.06)s;溶栓后48h则显著缩短,分别为(14.58±2.79)s及(22.76±4.84)s,溶栓前后差异均有显著统计学意义(均为P<0.01)。结论选择性介入溶栓治疗视网膜中央动脉阻塞,可及时有效恢复视网膜血供,缩短臂-视网膜显影及视网膜动-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 retinal morphological changes in central retinal artery occlusion（CRAO）by optical coherence tomography（OCT）and fundus fluorescein angiography（FFA）before and after intra-arterial thrombolysis.Methods Seventy patients with CRAO were treated with selective intra-arterial thrombolysis,the fundus graph,OCT and FFA changes were recorded before thrombolysis and 48 hours,1 month after thrombolysis,the arm-retina and retinal artery-vein development time in FFA before thrombolysis and 48 hours after thrombolysis were also recorded.Results The macular thickness before thrombolysis and 48 hours after thrombolysis were obviously increased,the central macular fovea were（265.00±105.93）μm and（269.00±99.04）μm,compared with the healthy eyes（161.00±18.06）μm,there were statistical differences.The macular thickness at 1 month after thrombolysis was decreased,the central macular fovea were（139.00±34.11）μm,compared with that before thrombolysis and healthy eyes,there were statistical difference（all P〈0.05）.The main findings on fundus before thrombolysis were retinal arterial attenuation,retinal opacity in the posterior pole,cherry-red spot,that at 48 hours after thrombolysis were retinal arterial recovery and retinal edema,that at 1 month after thrombolysis were decreased retinal edema,but the optic disc and retinal nerve fiber layer were atrophied.The arm-retina and retinal artery-vein development time before thrombolysis were obviously prolonged,which were（30.65±7.11）s and（39.82±7.06）s,the time at 48 hours after thrombolysis were shortened,which were（14.58±2.79）s and（22.76±4.84）s,there were statistical differences（all P〈0.01）.Conclusion The selective intra-arterial thrombolysis can improve retinal circulation significantly,shorten the arm-retina and retinal artery-vein development time,but the morphological damages of retinal nerve tissue in all eyes with CRAO are identified.