视网膜中央动静脉合并阻塞的临床观察

Clinical analysis of combined central retinal artery and vein occlusion

目的观察视网膜中央动静脉合并阻塞患者的临床特征。方法回顾分析8例经眼底检查和（或）荧光素眼底血管造影（FFA）检查确诊的视网膜中央动静脉合并阻塞患者的临床资料。分析其发病原因、眼底表现、FFA特征。结果8例患者中，4例患者有高血压病同时伴血脂异常；2例患者有眼部外伤致球后出血；1例患者有眶蜂窝织炎；1例患者有系统性红斑狼疮病。8例患者视网膜后极部水肿、出血，视网膜动脉极细，静脉纡曲扩张，视盘水肿。FFA检查结果显示，动脉前峰延迟，视网膜小动脉分支至造影晚期均未见充盈，视网膜大静脉层流延迟，分支静脉无充盈或逆行充盈；5例患者可观察到脉络膜大片圆点状、斑片状弱荧光。结论视网膜中央动静脉合并阻塞发病原因复杂。其眼底表现及FFA特征不典型，但同时具有视网膜中央动脉阻塞和视网膜中央静脉阻塞的特点。

Objective To observe the clinical features of combined central retinal artery and vein occlusion. Methods The clinical data of eight patients of combined central retinal artery and vein occlusion diagnosed by fundus examination and fundus fluorescein angiography （FFA） was analyzed retrospectively, including the causes, fundus manifestations and FFA features. Results 4/8 patients had hypertension and dyslipidemia, 2/8 patients had traumatic retrobulbar hemorrhage, one patient had orbital cellulitis and one patient had systemic lupus erythematosus. All the patients had posterior pole retinal edema, hemorrhage, thin retinal artery, dilated vein, and papilledema. FFA showed delayed arterial filling, and there was no filling of retinal arterial branches until the late stage of FFA. Laminar flow delayed in large retinal veins, and there was no filling or only retrograde filling in retinal vein branches. Large areas with dot-like or patchy weak choroidal fluorescence can be observed in five patients. Conclusions Combined central retinal artery and vein occlusion is rare with complex etiology. The fundus manifestations and FFA features are atypical, hut have features of central retinal artery occlusion and central retinal vein occlusion.