有髓神经纤维合并视网膜血管异常的临床观察

Clinical observation of myelinated nerve fibers with retinal vascular abnormalities

目的探讨先天性有髓神经纤维合并视网膜血管异常的临床特征。方法回顾分析我院诊治随访的合并视网膜血管异常的有髓神经纤维患者6例,总结其眼底表现及眼底荧光素血管造影特征,进而分析血管异常原因。结果 6例患者均可见有髓神经纤维沿视网膜神经纤维分布,视网膜血管异常发生于有髓神经纤维的视网膜区域:4例患者视盘旁有髓神经纤维附近可见火焰状的出血、视网膜血管走行迂曲,2例患者为视盘毛细血管扩张。眼底荧光素血管造影显示:有髓神经纤维较薄弱时常表现为正常荧光,较浓厚可表现为遮蔽荧光;合并视盘旁出血时表现为出血区域遮蔽荧光,毛细血管扩张的患者荧光造影显示血管扩张、荧光素渗漏,晚期呈片状强荧光。结论认识并关注由有髓神经纤维所引发的视网膜血管异常有着重要的临床意义,避免误诊为其他视网膜血管性疾病。对于合并新生血管和玻璃体出血的患者,要明确病因,早期给予激光或手术等及时正确的治疗。

Objective To investigate the clinical features of myelinated nerve fibers with retinal vascular abnormalities.Methods Retrospective analysis was taken in 6 patients of myelinated nerve fibers with retinal vascular abnormalities.Fundus fluorescein angiography was summarized and the reasons of vascular abnormalities were analyzed.Results Myelinated nerve fibers along with the retinal nerve fibers was observed in all patients.Vascular abnormalities occurred in the area of myelinated nerve fibers,flame-shaped hemorrhage and tortuous retinal blood vessels was seen near the optic disc in 4 patients,and optic disc telangiectasia in 2 patients.Fundus fluorescein angiography showed that late flaky strong fluorescence.angiography was normal if the myelinated nerve fibers were weak.However hypofluorescein was found if the myelinated nerve fibers were thick.Bleeding area shielded fluorescent in telagiectasia patients.Fundus fluorescein angiography showed dilated blood vessels,and fluorescein leakage,and strong fluorescence at late stage in dilated microvascular patients.Conclusions The awareness and concern of the myelinated nerve fibers associated with retinal vascular abnormalities have important clinical significance to avoid misdiagnosis of other retinal vascular diseases.For neovascularization and vitreous hemorrhage,laser or surgery can be provided.