鼻咽癌放疗后放射性视网膜病变的临床分析

Clinical studies of radiation retinopathy

为探讨放射性视网膜病变 ( Radiation Retinopathy,RR)的临床表现及光凝治疗的效果 ,对鼻咽癌外照射后发生的 13例 ( 2 6只眼 ) RR患者的临床表现、彩色眼底照相、眼底萤光血管造影 ( Fundus Fluorescein Angiography,FFA)和氩激光光凝治疗黄斑水肿 3眼进行回顾性分析。结果 :13例 RR患者 2 6只眼 ( 10 0 % )眼底改变为黄斑部毛细血管扩张和 /或微血管瘤 ,另外单独或同时伴视盘颜色变淡 11只眼 ,水肿、出血 6只眼 ;视网膜出血 2 2只眼 ,广泛性视网膜小血管闭塞 7只眼 ;黄斑水肿 11只眼 ,深层出血 1只眼。81% ( 2 1/ 2 6) RR患眼视力下降。光凝治疗后 6个月 10 0 % ( 3 / 3 )患眼视力提高及黄斑水肿消退。结论 :RR最早期和最常见表现为黄斑部毛细血管扩张和 /或微血管瘤。RR患者视力下降是由于黄斑部水肿、黄斑部毛细血管闭塞、视盘缺血等原因所致。氩激光光凝可有助于放射性黄斑水肿消退 。

Purposes:To investigate the clinical findingsand Argon laser photocoagulation to the macular edema in the patients with radia- tion retinopathy( RR) .Materials and Methods:13 patients( 2 6eyes) with RR retinopathy suffered from nasopharyngeal carcinomas receiving external beam radiation,of which the clinical findings,fundus color photography,fundus fluorenscein angioraphy( FFA) and Argon laser photocoagulation to macular edema involved in3 injured eyes were retrospectly studied.Results:Among the13 pa- tients2 6injured eyes,2 6eyes( 10 0 % ) complicated with telangiectasia and/ormicroaneurysms within the macular area,11eyes with optic disc palloralone or coinsistantly,disc edema and hemorrhagesseen in 6eyes,2 2 eyes with retinal hemorrhages,extensive small retinal vessels occlusion involved in 7eyes,11eyes with macular edema,1eye with intraretinal hemorrhages.The decreased vision happened in 2 1eyes ( 81% ) .The visual acuity had improved in 3 eyes with macularedema 6months after photocoagulation,and the macular edema also disappeared.Conclusions:The telangiectasia and/or microaneurysms within the macular area were firstly in- volved and the most common features in the patients with RR.The decreased vision in the patients came from macular edema and capillary occlusion as well as optic nerve ischemia etc.Argon laser photocoagulation could contribute to fadeaway of post- radiation macular edema and improve the visual acuity.