急性视网膜坏死伴视网膜中央动脉阻塞的临床观察

Clinical observation of acute retinal necrosis complicated with central retinal artery occlusion

目的:观察急性视网膜坏死(acute retinal necrosis,ARN)并视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)的临床特征并进行文献复习。方法:回顾云南省第二人民医院于2015年1月至2019年9月确诊的ARN合并视网膜中央动脉的患者6例(8眼),结合病史、病情发展、转归及影像学检查表现进行分析,并结合以往相关文献报道,对ARN合并视网膜中央动脉这一少见病例的临床表现进行总结。结果:眼底彩色照相及超广角照相可见玻璃体轻至中度混浊,视网膜苍白水肿,以周边视网膜明显,后极部视网膜动脉白线,周边视网膜血管闭塞,伴动脉走行可见大量出血,视网膜大片斑状黄白色渗出;眼底荧光造影可见荧光素充盈不同程度延迟,视网膜散在少许斑状出血遮蔽荧光,视网膜动脉管径细,各方向周边视网膜血管闭塞,大片低荧光无灌注区形成。眼底(optical coherence tomography,OCT)结果显示后极部视网膜水肿增厚,以内层视网膜水肿危重,层次结构欠清晰。部分区域可见神经上皮下液。结论:ARN合并CRAO虽然较为少见,但会进一步严重破坏患者视功能,因此CRAO应该被知晓为一类ARN严重并发症,在对ARN患者诊断和治疗的过程中应加强对CRAO的风险认识和评估。

Objective:To observe the clinical features of acute retinal necrosis(ANR)complicated with central retinal artery occlusion(CRAO).Methods:Six patients(8 eyes)diagnosed with ARN complicated with CRVO in our hospital from January 2015 to September 2019 were reviewed.The medical history disease progression,prognosis and the performance of fundus imaging were analyzed to summarize the clinical manifestations of these rare cases.Results:Color photography and ultra-wide-angle photography of the fundus showed mild to moderate opacity of the vitreous body,pale edema of the retina,white lines of posterior pole retinal arteries,occlusion of peripheral retinal vessels,massive bleeding with arterial course,and large patches of yellow retina.Fundus fluorescein detected different degrees of fluorescein filling delay,scattered light spots in the retina to block the fluorescence,small retinal arterial diameter,peripheral retinal vessel occlusion in all directions,and large areas of non-perfusion area.The fundus OCT showed that the posterior pole retinal edema was thickened,the inner retinal edema was severe,and the layered structure was not clear.Subepithelial fluid was seen in some areas.Conclusion:Although ARN complicated with CRAO is relatively rare,it can aggravate damage to the visual function of patients.Therefore,CRAO should be known as a serious complication of ARN.The risk of CRAO should be monitored and assessed during the diagnosis and treatment of ARN.