视网膜中央动脉阻塞患眼超选择性眼动脉溶栓治疗前后黄斑区视网膜厚度变化

The changes in macular thickness at multiple locations before and after thrombolysis in patients with central retinal artery occlusion

目的观察视网膜中央动脉阻塞(CRAO)患眼超选择性眼动脉溶栓(IAT)治疗前后黄斑中心视网膜厚度(CRT)变化情况。方法回顾性临床研究。2022年8月至2023年9月于深圳市第二人民医院眼科检查确诊并行IAT治疗的CRAO患者12例12只眼纳入研究。其中,男性8例8只眼,女性4例4只眼;均为单眼发病。患者年龄(47.00±15.06)岁,发病至溶栓时间为(30.00±30.42)h。所有患眼均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)检查;同时行荧光素眼底血管造影(FFA)检查6只眼。BCVA检查采用标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。采用OCT仪测量患眼黄斑中心凹(M)以及分别距中心凹小凹1、3 mm处上方(S1、S3)、下方(I1、I3)、鼻侧(N1、N3)、颞侧(T1、T3)CRT。CRT定义为视网膜内界膜至视网膜色素上皮层强反射带内侧界面之间的垂直距离。IAT治疗后24 h采用治疗前相同设备和方法行相关检查。对比观察黄斑区不同点位CRT的变化情况;行FFA检查的6只眼,对比观察动脉显影时间的变化。治疗前后logMAR BCVA、不同点位CRT、动脉显影时间比较采用配对检验。结果IAT治疗前,患眼logMAR BCVA为3.48±1.42;行FFA检查的6只眼,动脉显影时间为(27.50±5.47)s。治疗后24 h,患眼logMAR BCVA为2.35±1.59,BCVA较治疗前不同程度提高9只眼;动脉显影时间为(24.17±7.28)s。治疗前后患眼logMAR BCVA、动脉显影时间比较,差异有统计学意义(t=2.489、3.262,P<0.05)。治疗前后患眼S3(t=2.871)、I1(t=2.325)、T3(t=3.446)处CRT比较,差异有统计学意义(P<0.05);S1(t=1.879)、I3(t=1.915)、N1(t=2.001)、N3(t=1.987)、T1(t=2.180)、M(t=-0.490)处CRT比较,差异均无统计学意义(P>0.05)。结论IAT可有效治疗CRAO,降低CRT,但短期内黄斑区视网膜水肿消退程度有限。

Objective To observe alterations in center retinal thickness(CRT)in patients diagnosed with central retinal artery occlusion(CRAO)before and after undergoing superselective arterial thrombolysis(IAT)treatment.Methods A retrospective clinical study.From August 2022 to September 2023,12 patients(12 eyes)diagnosed with CRAO and treated with IAT at the ophthalmology department of Shenzhen Second People's Hospital.Among these patients,there were 8 males(8 eyes)and 4 females(4 eyes),all experiencing unilateral onset.The mean age was(47.00±15.06)years.The mean duration from onset to thrombolysis was(30.00±30.42)h.All eyes underwent best corrected visual acuity(BCVA)and optical coherence tomography(OCT)assessments;additionally,6 eyes underwent Fluorescein fundus angiography(FFA).BCVA assessments were conducted using a standard logarithmic chart and transformed into logarithm of the minimum angle of resolution(logMAR)values for statistical analysis.The OCT measured CRT at various locations around the macular fovea(M),including upper(S1,S3),lower(I1,I3),nasal(N1,N3),and temporal(T1,T3)areas at 1 mm and 3 mm distances from the fovea.CRT was defined as the vertical distance between the inner retinal boundary membrane and the inner interface of the retinal pigment epithelial layer.Pre-and post-IAT examinations were performed using the same equipment and methodologies within a 24-hour interval.Changes in CRT at different macular points were compared and observed,while arterial imaging time changes were assessed in 6 eyes that underwent FFA.Paired t-tests were utilized to analyze logMAR BCVA,CRT at different locations,and arterial imaging time pre-and post-treatment.Results Prior to IAT treatment,the logMAR BCVA for the affected eye was 3.48±1.42,while the arterial imaging time for the 6 eyes undergoing FFA examination was(27.50±5.47)s.After 24 hours,the logMAR BCVA had improved to 2.35±1.59 for the affected eye,with 9 eyes showing varying degrees of BCVA improvement.The arterial imaging time was(24.17±7.28)s post-treatment.The differences in logMAR BCVA and arterial imaging time before and after treatment were found to be statistically significant(t=2.489,3.262;P<0.05).Additionally,the comparison of CRT at S3(t=2.871),I1(t=2.325),and T3(t=3.446)before and after treatment yielded statistically significant differences(P<0.05).Conversely,the comparison of CRT at S1(t=1.879),I3(t=1.915),N1(t=2.001),N3(t=1.987),T1(t=2.180),and M(t=-0.490)showed no statistically significant differences(P>0.05).Conclusions IAT treatment for CRAO has been shown to be effective in achieving therapeutic effects by reducing CRT in the macular area.However,the shortterm improvement in retinal edema in the macular area is limited.