青少年视网膜动脉阻塞九例临床特征观察

Clinical analysis of youth patients with retinal arterial occlusions

目的 观察青少年视网膜动脉阻塞（RAO）患者的临床特征.方法 回顾性病例分析.临床检查确诊的青少年RAO患者9例9只眼纳入研究.患者中,男性6例6只眼,女性3例3只眼;均为单眼.平均年龄（14.22±3.93）岁.均行最佳矫正视力（BCVA）、间接检眼镜、眼底彩色照相、荧光素眼底血管造影检查.实验室血常规、红细胞沉降率、血脂、血管炎筛查、同型半胱氨酸、抗磷脂抗体、凝血功能检查.颈动脉彩色超声、心脏彩色超声、心电图检查.明确诊断后给予吸氧、扩张血管药物及对症治疗;免疫系统性疾病者全身给予糖皮质激素治疗.治疗后随访6-12个月.对比观察治疗前后视力及眼底变化.结果 9例患者中,系统性红斑狼疮1例;先天性心脏病1例;高球蛋白血症1例;颈动脉彩色超声检查提示颈内动脉血管走行纡曲2例.患眼BCVA 0.01-0.12.视网膜分支动脉阻塞（BRAO）5只眼,占55.6％;视网膜中央动脉阻塞（CRAO）2只眼,占22.2％;睫状视网膜动脉阻塞（CLAO）2只眼,占22.2％.CRAO者2只眼,相对性传入性瞳孔障碍阳性;视网膜动脉及相应静脉变细,后极部视网膜呈灰白色水肿,黄斑区樱桃红点.BRAO者5只眼均为颞下分支动脉阻塞,其周围视网膜灰白色水肿.CLAO者2只眼,视网膜颞侧呈舌形灰白色水肿.末次随访时,BCVA提高者7只眼,占77.8％;不变者2只眼,占22.2％.BCVA提高者7只眼,视网膜受阻血管恢复正常血流;不变者2只眼,眼底未见改善.结论 青少年RAO多为视网膜动脉不全阻塞;经早期积极治疗后一般预后较好.

Objective To observe the clinical features of retinal arterial occlusion （RAO） in youth.Methods This is a retrospective case review.Nine patients （9 eyes） with RAO were enrolled in this study.There were 6 males （6 eyes） and 3 females （3 eyes）.The average age was （14.22± 3.93） years.The best-corrected visual acuity （BCVA）,indirect ophthalmoscopy,fundus color photography and fundus fluorescein angiography were performed.All patients underwent systemic evaluation including blood routine,erythrocyte sedimentation rate,blood lipids,vasculitis screening,homocysteine level,antiphospholipid antibody,blood coagulation,neck vascular ultrasound,and cardiac color ultrasound and electrocardiogram examination.All patients received oxygen therapy,blood medications and symptomatic treatment.Meanwhile,the patients with autoimmune diseases were received systemic glucocorticoid therapy.The follow-up was ranged from 6 to 12 months.The visual acuity and fundus change before and after treatment were compared.Results among 9 patients,one patient had systemic lupus erythematosus,one patient had congenital heart disease,one patient had hypergammaglobulinemia,and carotid artery color ultrasonography showed that the internal carotid artery vessels faltered in 2 cases.The BCVA was 0.01-0.12.Among 9 eyes,there were 5 eyes （55.6%） with retinal branch artery occlusion （BRAO）,2 eyes （22.2%） with central retinal artery occlusion （CRAO）,2 eyes （22.2%） with ciliary retinal artery occlusion （CLAO）.CRAO eyes showed positive RAPD （relative afferent pupillary defect）,fine retinal artery and the corresponding vein,pale white retinal edema in posterior area and macular cherry-red spot.BRAO eyes manifested as inferior temporal artery occlusion and pale white retinal edema around them.CLAO eyes showed temporal ligulate grey-white retinal edema.At the last follow-up,BCVA improved and retinal vessels returned to normal in 7 eyes （77.8%）;BCVA unchanged and no improvement in fundus in 2 eyes （22.2%）.Conclusion Adolescent RAO is mostly partial occlusion,the prognosis is generally good after early active treatment.