睫状视网膜动脉对非动脉炎性视网膜中央动脉阻塞患眼中心视力的影响

Influence of cilioretinal artery on central visual acuity of eyes with non-arteritic central retinal artery occlusion

目的 观察非动脉炎性视网膜中央动脉阻塞(NA-CRAO)患者睫状视网膜动脉对患眼起病时中心视力的影响,探讨其预后。方法 2011年9月—2023年3月河南省人民医院诊治NA-CRAO患者216例(216眼),均行荧光素眼底血管造影检查显示视网膜动脉主干-末梢荧光充盈间期≥5 s,其中无睫状视网膜动脉151例(151眼)为无睫网动脉组,存在睫状视网膜动脉且睫状视网膜动脉供养黄斑区15例(15眼)为黄斑组,存在睫状视网膜动脉但睫状视网膜动脉不供养黄斑区50例(50眼)为非黄斑组。比较3组性别比例、年龄、发病至就诊时间、合并症(高血压、糖尿病、高胆固醇血症、冠状动脉疾病)、吸烟史、饮酒史、脑梗死病史;入院时行光学相干断层扫描,测量患眼及健眼黄斑中心凹视网膜厚度(CRT)。3组均采用保守治疗,分别于入院时及治疗1、3个月检测患眼最佳矫正视力(BCVA),并将BCVA换算为最小分辨角对数(logMAR)视力。结果 (1)3组年龄,发病至就诊时间,男性、吸烟、饮酒、有脑梗死病史及合并高血压、糖尿病、高胆固醇血症、冠状动脉疾病比率比较差异均无统计学意义(P>0.05)。(2)3组入院时患眼CRT比较差异有统计学意义(F=4.558,P=0.012),健眼CRT比较差异无统计学意义(F=0.277、P=0.758)。入院时黄斑组患眼CRT[(319.87±40.33)μm]小于无睫状视网膜动脉组[(358.94±49.46)μm]和非黄斑组[(355.66±44.51)μm](P<0.05),无睫状视网膜动脉与非黄斑组比较差异无统计学意义(P>0.05)。(3)3组入院及治疗1、3个月时BCVA(logMAR)比较差异均有统计学意义(P<0.05),治疗1、3个月时BCVA(logMAR)与入院时比较差异均无统计学意义(P>0.05)。黄斑组入院及治疗1、3个月时BCVA (logMAR)(1.72±0.99、1.50±0.87、1.40±0.80)均好于无睫状视网膜动脉组(2.38±0.81、2.29±0.79、2.25±0.78)和非黄斑组(2.51±0.79、2.44±0.82、2.37±0.82)(P<0.05),无睫状视网膜动脉组与非黄斑组比较差异均无统计学意义(P>0.05)。结论 NA-CRAO患者采用保守治疗后患眼中心视力无明显改善;供养黄斑区的睫状视网膜动脉可保护NA-CRAO患眼起病时的中心视力,未供养黄斑区的睫状视网膜动脉对患眼的中心视力无保护作用。

Objective To observe the influence of the cilioretinal artery on the central visual acuity of the affected eyes at the onset of non-arteritic central retinal artery occlusion(NA-CRAO),and to investigate the prognosis.Methods From September 2011 to March 2023,216 patients(216 eyes) with NA-CRAO underwent fundus fluorescein angiography in Henan Provincial People's Hospital,showing that the fluorescence filling interval between the main trunk and the distal end of the retinal artery was≥5 s,among whom 151 patients(151 eyes) were found no cilioretinal artery(non-cilioretinal artery group),15 patients(15 eyes) were found cilioretinal artery which supplied the macular area(macula group),and 50 patients(50 eyes) were found cilioretinal artery which did not supply the macular area(non-macula group).The gender ratio,age,time from onset to visit,comorbidities(hypertension,diabetes,hypercholesterolemia,coronary artery disease),smoking habits,alcohol consumption,and cerebral infarction were compared among three groups.On admission,optical coherence tomography was performed to measure the central retinal thickness(CRT) of the affected and healthy eyes.All three groups received conservative treatment.The best-corrected visual acuity(BCVA) was measured on admission,and after 1-and 3-month treatment,and the BCVA was converted to logMAR visual acuity.Results(1) There were no significant differences in the age,time from onset to visit,male ratio,and proportions of smoking habits,alcohol consumption,cerebral infarction,and comorbidities,(hypertension,diabetes,hypercholesterolemia,coronary artery disease) among three groups(P>0.05).(2) There was a significant difference in the CRT of the affected eyes among three groups on admission(F=4.558,P=0.012),and no significant difference in the CRT of the healthy eyes(F=0.277,P=0.758).The CRT of the affected eyes was thinner in macula group[(319.87±40.33)μm] than that in non-cilioretinal artery group [(358.94±49.46) μm] and non-macula group[(355.66±44.51) μm] [P<0.05),and showed no significant difference between non-cilioretinal artery group and non-macula group(P>0.05).(3) There were significant differences in the BCVA(logMAR) among three groups on admission,and after 1-and 3-month treatment(P<0.05).The BCVAs(logMAR) showed no significant differences after 1-and 3-month treatment compared with those on admission in three groups(P>0.05).The BCVAs(logMAR)were better in macula group on admission and after 1-and 3-month treatment(1.72±0.99,1.50±0.87,1.40±0.80)than those in non-cilioretinal artery group(2.38±0.81,2.29±0.79,2.25±0.78) and non-macula group(2.51±0.79,2.44±0.82,2.37±0.82)(P<0.05),and showed no significant difference between non-cilioretinal artery group and non-macula group(P>0.05).Conclusions Conservative treatment achieves no obvious improvement in the central visual acuity of the NA-CRAO affected eyes.The cilioretinal artery supplying the macular area can protect the central visual acuity of the affected eyes at the onset of NA-CRAO,while the cilioretinal artery supplying no macular area has no protective effect.