视神经切开术治疗视网膜中央静脉阻塞的初步报告

Optic neurotomy for central retinal vein occlusion

目的 探讨视神经切开术治疗缺血性视网膜中央静脉阻塞的效果及其并发症。方法选择缺血性视网膜中央静脉阻塞患者 8例 ,病程 3～ 8个月 ,平均 3 6个月。患者均经系统药物治疗 3个月效果不佳 ,其中 3例有高血压病史 ,3例患有严重的黄斑囊样水肿。术前患者均行眼底照相、荧光素眼底血管造影 (FFA)及相干光断层扫描 (OCT)检查。手术常规做睫状体平坦部巩膜三切口 ,应用显微玻璃体视网膜切开刀 ,以鼻侧视乳头边缘为中心 ,垂直刺入达最宽处为止 ,刺入深度约 2 2mm ,宽度约 1 2mm。术后 1～ 3个月分别行眼底照像、FFA及OCT检查。结果 术后随访 3～ 5个月。术后 1个月内 ,所有患者视网膜或黄斑水肿均减轻或消退。术后 3个月 ,患者行眼底照像、FFA及OCT检查结果均显示视网膜出血吸收 ,视乳头黄斑水肿消退 ;6例视力较术前提高 (6 2 5 % )。术后 3～ 4周 ,2例发生玻璃体出血 ,其中 1例继发新生血管性青光眼 ;2例术中穿刺时出血。结论 视神经切开术有助于视网膜内出血、渗出及黄斑水肿的消退 ,部分患者视力可得到改善。

Objective To investigate the surgical effect and complication of optic neurotomy for ischemic central retinal vein occlusion (CRVO). Methods Eight patients elected to undergo optic neurotomy ,The age range was 32-67 years, Five of the 8 were women and three were men. The duration of the CRVO were 3-8 months. Systemic hypertension was present in 3 patients and severe cystoid macular edema was present in 3 patient. No diabetes mellitus was noted in all 8 patients. A standard three-port vitrectomy was performed on 8 patients with severe ischemic CRVO, A microvitreoretinal (MVR) blade was used to relax the scleral ring and adjacent sclera of the optic disk, The depth of the incision into the optic nerve placed the MVR blade just beyond the widest portion of the diamond-shaped tip. The depth of the incision was 2.2 mm approximately. Results Optic neurotomy was performed in all 8 patients successfully, The small hemorrhage was noted during the surgical procedure in 2 patients limited to the incision site. The follow-up was 3-5 months range, All patients had improvement in the retina and macular edema and the appearance of the fundus as documented by photography,fluorescein angiography. And optic coherence tomography(OCT). Postoperative visual acuities were improved in 62.5% of patients and the visual acuities no changes were in 2 patients. Postoperative neovascular glaucoma was in 1 patient and vitreous hemorrhage in 2 patients. Conclusions Optic neurotomy may improve the intraretinal hemorrhage, macular edema and the visual acuity prognosis in patients with ischemic CRVO.