低灌注性视网膜病变的临床观察

Clinical analysis of low pressure retinopathy

目的探讨颈内动脉狭窄引起的低灌注视网膜病变的临床特征、诊断方法及治疗原则。方法收集临床诊断为低灌注性视网膜病变的病例资料17例(19只眼),对其临床特征、眼部体征、影像学检查及诊断等进行分析。结果颈动脉狭窄引起的低灌注性视网膜病变多发生于中老年人,眼部的临床表现较为隐蔽,17例均以视力下降就诊,2例有虹膜新生血管,1例有轻微的眼眶疼痛感。颈眼动脉彩色多普勒检查17例,主要表现为不同程度的颈动脉狭窄。荧光素眼底血管造影(FFA)示17例均有臂-视网膜循环时间延长,最短14 s,最长45 s视网膜动静脉循环时间延长最短27 s,最长240 s。6例出现动脉、静脉管壁染色,且动脉染色较甚。9例出现点片状或墨迹状出血。7例出现动脉变细和残端样改变。11例发现毛细血管无灌注区,4例出现黄斑囊样水肿,2例出现视盘新生血管。结论颈内动脉狭窄引起的低灌注性视网膜病变易误诊为视网膜中央动脉阻塞或中央静脉阻塞等疾病,确诊需要颈动脉血管的检查。它是值得眼科医生高度重视的一种严重致盲性疾病。

Objective To analyze the clinical aspects ,treatment Principal of the low pressure retinopathy caused by the internal carotid artery stenosis. Methods The clinical aspect Of 17 low pressure retinopathy cases were analyzed, which included symptoms, signs imageology, diagnosis. Rusults The low pressure retinopathy was more prevalent in elderly,and signs usually occurred disobviously. The main symptoms were vision loss. 2 cases found iris neovascularization sl ca- ses found ischemic pain. Color-ceded imaging examination was performed in 17 cases, which found that carotid artery stenosis Fluorescein agiography was performed 17cases. 6 cases found staining of both retinal veins and arteries and retinal arter- ies staining is more prominent than retinal vein staining. 7 cases found arteries thinner. 11cases found widespread capillary drop-out in the mid-peripberal . 4 ases found macular edema. 9cases found dot and blot hemorrhages in the mid- periphery . cases found optic disk neovaseularization. Conclusion The low pressure retinopathy caused by the internal carotid artery stenosis can be easily misdiagnosed as other types of central retinal artery occlusion and central retinal wein occlision. The diagnosis of the low pressure retinopathy can be established by radiology examinations, the low pressure retinopathy caused by the internal carotid artery stenosis should be attached greatly by ophthalmologist and it is a serious blind eye disease.