视网膜分支静脉阻塞伴行的动脉改变及其对预后影响

The subsequent arterial change and its effect on prognosis in the branch retinal vein occlusion

目的观察视网膜分支静脉阻塞(BRVO)伴行的动脉变化及其对预后的影响。设计回顾性病例系列。研究对象黑龙江省医院121例(124眼)BRVO患者。方法观察不同病程的BRVO患者荧光素眼底血管造影(FFA)的影像资料,分析不同病程伴行的动脉变化对视网膜无灌注区的形成、新生血管的发生及视神经的影响。主要指标FFA图像中视网膜动脉管径及充盈时间等改变。结果早期患者64眼中,动脉管径扩张且荧光素渗漏严重者27眼(42.19%),其中19眼(70.37%)在病变晚期出现了超过7 PD的大片无灌注区,而动脉正常或受累轻微的37眼中仅7眼出现大片无灌注区(P<0.05)。所有患者中38眼(30.68%)病变晚期发生小动脉闭塞;18眼(14.52%)阻塞静脉与伴行动脉的远端出现一致性闭塞;5眼(4.03%)伴行动脉干不同程度闭塞。65眼(52.41%)出现大片毛细血管无灌注区,其中49眼(75.38%)发生视盘或视网膜新生血管,而与动脉有关的新生血管有16眼(43.24%)。结论 BRVO伴发的视网膜动脉受累(如早期患者动脉充盈延缓、管径扩张,晚期患者动脉管径缩窄、小动脉闭塞等)程度可作为早期判断有无无灌注区、识别发生新生血管高危眼以及对BRVO分型的参考指征。

Objective To observe subsequent arterial change of branch retinal vein occlusion （BRVO） and its effect on prognosis. Design Retrospective case series. Participants 124 eyes of 121 patients with BRVO in Heilongjiang Provincial Hospital. Methods The clinical data of fundus fluorescence angiography （FFA） of the patients with BRVO were analyzed to study the effect of the subsequent arterial change on retinal nonperfnsion area, neovascularization and optic nerve. Main Outcome Measures Changes of filling time and diameter of retinal artery on FFA. Results In 64 early cases, there were the images of 27 eyes （42.19%） that showed the retinal artery expanded and fluorescence leaked seriously. In these eyes, there were 19 eyes （70.37%） with the extensive retinal nonperfusion areas at the late stage. In the other 37 eyes with retinal artery normal or mild changed, there were only 7 eyes with the extensive retinal nonperfusion areas. The difference was statistically significant （P〈0.05）. In the total 124 eyes, there were 38 eyes （30.68%） with small retinal artery occlusion at the late stage, 18 eyes （I4.52%） with the coherent occlusion at the distal end of occluded vein and accompanying reti- nal artery, 5 eyes （4.03%） with accompanying retinal artery trunk occlusion. In 65 eyes with the extensive retinal capillary vessel non perfusion areas, there were 49 eyes （75.38%） with neovascularization on optic disk and retina, 16 eyes （43.24%） with neovascularization from accompanying artery. Conclusions The demages of involved arteries in BRVO （such as delayed filling, expended vessel in early stage, and narrowing arteries and obstructed branched in late stage） can be reference guides on early judging whether nonperfusion area exist, can identify the high risk of the neovescularization, and can be a reference index of classifying the BRVO.