光相干断层扫描血管成像对视网膜静脉阻塞中侧支循环的观察

Observation of collateral circulation in retinal vein occlusion by optical coherence tomography angiography

目的观察不同类型视网膜静脉阻塞患眼侧支循环的临床特征。方法回顾性临床研究。2021年12月至2023年12月于云南大学附属医院眼科检查确诊的单眼视网膜静脉阻塞患者360例360只眼纳入研究。其中,男性157例157只眼,女性203例203只眼;年龄(61.0±5.9)岁;出现症状至就诊时病程为3 d~6个月。黄斑分支静脉阻塞(MBRVO)、视网膜分支静脉阻塞(BRVO)、视网膜中央静脉阻塞(CRVO)分别为67、187、106只眼;合并黄斑水肿210只眼。合并黄斑水肿者均给予玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗。患眼均行扫频源光相干断层扫描检查。观察视网膜侧支循环的发生率、部位、形态特点、形成时间以及抗VEGF药物治疗对侧支循环形成的影响。将从视盘发出呈血管袢样的血管在视盘走形一段后回到视盘的短路循环定义为视盘睫状血管短路型侧支循环。结果病程1周时,MBRVO、BRVO患眼部分侧支循环已建立;1~2个月时,已建立较为丰富而稳定的侧支循环。病程2~3个月时,CRVO患眼视盘睫状血管短路型侧支循环逐渐形成。病程6个月时,MBRVO者67只眼中,侧支循环建立36只眼(53.7%,36/67);BRVO者187只眼均观察到侧支循环(100.0%,187/187);CRVO者106只眼中,视盘侧支循环建立29只眼(18.1%,29/106)。MBRVO者中建立侧支循环的36只眼,其侧支循环均建立于阻塞区域和非阻塞区域之间的垂直水平缝处。BRVO者187只眼中,侧支循环建立于阻塞区域和非阻塞区域之间的垂直水平缝处102只眼;阻塞最中央逐级搭桥至正常血管上的侧支循环54只眼;通过鼻侧与颞侧建立侧支循环19只眼;通过中心凹建立的侧支循环12只眼。其形态表现为平直走形、螺旋状纡曲和花簇状。CRVO建立侧支循环的29只眼,均为视盘睫状血管短路型侧支循环。行抗VEGF药物治疗的210只眼中,侧支循环建立160只眼。其中,MBRVO 32只眼(62.0%,32/63);BRVO 119只眼(100.0%,119/119);CRVO 9只眼(32.1%,9/28)。结论MBRVO、BRVO、CRVO侧支循环发生率分别为53.7%、100.0%、18.1%,其形态多样,形成时间多为病程2个月左右。抗VEGF药物治疗未抑制侧支循环的建立。

Objective To observe the clinical features of collateral circulation in different types of retinal vein occlusion.Methods A retrospective clinical study.A total of 360 patients with monocular retinal vein occlusion diagnosed by ophthalmic examination in Department of Ophthalmology of Yunnan University Affiliated Hospital from December 2021 to December 2023 were included in the study.Among them,157 males had 157 eyes and 203 females had 203 eyes.Age were(61.0±5.9)years.The duration of the disease from the onset of symptoms to the time of treatment was 3 days to 6 months.Macular branch vein occlusion(MBRVO),retinal branch vein occlusion(BRVO)and central retinal vein occlusion(CRVO)were observed in 67,187 and 106 eyes,respectively.210 eyes were with macular edema.All patients with macular edema were treated with anti-vascular endothelial growth factor(VEGF)by intravitreal injection.All eyes were examined by scanning source optical coherence tomography.The incidence,location,morphological characteristics,formation time of retinal collateral circulation and the effect of anti-VEGF drug on the formation of collateral circulation were observed.A short circuit in which blood vessels originating from the optic disc in the form of a blood loop return to the optic disc after the disc has been deformed for some time is defined as a short-circuited collateral circulation of the ciliary vessels of the optic disc.Results After 1 week of disease course,MBRVO and collateral circulation of BRVO affected eye were established.By 1 to 2 months,a relatively abundant and stable collateral circulation had been established.In the course of 2 to 3 months,the short-circuit collateral circulation of ciliary vessels in the optic disc of the affected eye gradually formed.At 6 months,collateral circulation was established in 36 eyes(53.7%,36/67)in 67 MBRVO patients.Collateral circulation was observed in 187 eyes of BRVO patients(100.0%,187/187).In 106 eyes with CRVO,collateral circulation was established in 29 eyes(18.1%,29/106).In 36 eyes with MBRVO,collateral circulation was established at the vertical horizontal slit between the blocked area and the non-blocked area.In 187 eyes of BRVO patients,collateral circulation was established in the vertical horizontal slit between the blocked and non-blocked areas in 102 eyes;54 eyes were blocked the most central bypass to the collateral circulation on normal blood vessels.The collateral circulation of 19 eyes was established through nasal and temporal side.Collateral circulation through the fovea was established in 12 eyes.Its morphology is straight out of shape,spiral sinuous and flower cluster.CRVO established collateral circulation in 29 eyes,all of which had short-circuit collateral circulation of ciliary vessels.In 210 eyes treated with anti-VEGF drugs,collateral circulation was established in 160 eyes.Among them,32 eyes were MBRVO(50.7%,32/63),BRVO 119 eyes(100.0%,119/119),CRVO 9 eyes(32.1%,9/28).Conclusions The incidence of collateral circulation of MBRVO,BRVO and CRVO is 53.7%,100.0%and 18.1%,respectively.The forms of MBRVO were varied and the course of disease is about 2 months.Anti-VEGF therapy did not inhibit the establishment of collateral circulation.