动脉内溶栓治疗视网膜中央动脉阻塞的研究进展

Research progress on intra-arterial thrombolysis for the treatment of central retinal artery occlusion

视网膜中央动脉阻塞(CRAO)又称为眼卒中,常导致急性无痛性的视力丧失。CRAO的保守治疗措施有眼球按摩、降低眼压,使用血管扩张药物等,均在临床应用中收效甚微。随着动脉内溶栓(IAT)在急性缺血性脑卒中的治疗中展现出来积极的作用,IAT也逐渐被应用到CRAO的治疗中,并显示出一定的疗效。IAT是通过微导管将纤维蛋白溶解药物直接注入眼动脉,从而溶解阻塞视网膜中央动脉的栓子,以恢复视网膜的血流。从理论上讲,CRAO患者接受IAT治疗后应该具有与脑卒中治疗相同的良好效果,但目前各项临床研究的结果并不一致。本文总结了IAT治疗CRAO的可行性、有效性及安全性,并分析影响预后的相关因素,提出未来可能的发展方向,为IAT在CRAO治疗中的进一步临床应用提供依据。

Central retinal artery occlusion(CRAO),also known as eye stroke,always results in acute and painless visual loss.At present,conservative treatments,such as eye massage,lowering intraocular pressure and vasodilators have little effect on reducing visual loss.Intra-arterial thrombolysis(IAT)has significantly improved prognosis in patients with acute ischemic stroke,thus IAT has been gradually applied in the treatment of CRAO.IAT injects fibrinolytic drugs directly into the ophthalmic artery by a microcatheter,and dissolves the emboli that block the central retinal artery to restore the blood flow of the retina.Theoretically,IAT may be effective for CRAO as what has been found for stroke,but existing clinical studies exhibited inconsistent results.This paper summarizes the feasibility,efficacy,and safety of IAT treatment in CRAO.It will also analyze related factors that affect the prognosis,putting forward potential development directions and providing insights for the further clinical application of IAT.