涡静脉回流障碍所致眼底改变的动态探究

发布时间：2018-05-27 11:37

本文选题：涡静脉 + 结扎　；参考：《北京协和医学院》2017年博士论文

【摘要】：背景涡静脉是眼球的主要回流静脉,是脉络膜静脉的唯一回流途径。涡静脉回流系统的异常可导致眼前节和眼底的多种病理生理改变,可引起前节缺血,虹膜新生血管生成,并与很多眼底疾病,如高度近视、糖尿病视网膜病变、中心性浆液性脉络膜视网膜病变、年龄相关性黄斑变性以及息肉状脉络膜血管病变的发病机制相关。涡静脉循环障碍后可能引起脉络膜血管结构和功能的改变和脉络膜静脉血流动力学的改变。目的通过建立涡静脉结扎动物模型,探究涡静脉结扎后造成的急性期和慢性期的眼部改变,评价急性期和慢性期脉络膜血流动力学的变化,以及评估脉络膜血管结构功能的变化。方法将11只食蟹猴分为A、B、C三组,每组随机抽取一只眼为实验眼,另一只眼为对照眼。A、B、C组实验眼分别给予结扎颞上和颞下象限2条涡静脉、只结扎颞下象限涡静脉,激光诱导脉络膜新生血管(CNV)模型后结扎颞上和颞下2条涡静脉三种不同的处理方法,建立涡静脉结扎动物模型。随访观察12周。每只眼分别于术前及术后当日、术后前三天、之后每周一次进行眼压测定及裂隙灯观察。每只眼分别于术前、术后1天、术后1周、4周、8周、12周进行眼底彩照(FP)、荧光素眼底血管造影(FFA)、吲哚菁绿眼底血管造影(ICGA)、相干光断层扫描(OCT)检查。对比分析各时间点各图像有无异常,ICG充盈速度和流空时间有无改变。利用Image J软件在ICGA图像对脉络膜血管直径进行测量分析。结果结扎涡静脉动物模型成功建立,但激光诱导CNV模型与涡静脉结扎术联合的方法建立动物模型不理想。实验组的眼压在术后当日、术后1天和术后2天明显高于对照组(P0.05 =。术后1周内出现了前房渗出、前房出血、虹膜淤血等眼前节缺血的表现。A组一只实验眼术后1周内FFA和ICGA上出现颞上和颞下大范围斑片状荧光渗漏的表现,术后4周发生荧光充盈迟缓甚至无荧光充盈,并随着时间延长更加明显。其他猴无类似表现。术后1天A、C组实验眼可见明显的颞侧脉络膜静脉充盈延迟(100%),术后1周恢复正常。术后4周开始A、C组的实验眼的结扎象限的脉络膜静脉发生缺如现象(发生率:A组87.5%,C组50%)。术后12周A、C组实验组的颞上象限的脉络膜血管直径低于对照组(P0.05),其他时间点实验组和对照组比未见明显差异。各组ICG排空时间未见统计学差异。OCT检查可见B组实验眼术后1周内颞下象限脉络膜较颞上象限脉络膜厚。结论涡静脉结扎动物模型可成功建立,结扎1-2条涡静脉可在短期内引起脉络膜循环障碍相应的表现,长期效应为脉络膜循环系统发生代偿性改变。结扎涡静脉的动物模型更适合于急性期脉络膜循环障碍的研究。
[Abstract]:Background Vortex vein is the main reflux vein of the eyeball and the only way of choroidal vein drainage. Abnormalities in the vortex venous reflux system can lead to multiple pathophysiological changes in the anterior segment and fundus, leading to anterior ganglion ischemia, angiogenesis of the iris, and many fundus diseases such as high myopia, diabetic retinopathy, Central serous chorioretinopathy, age-related macular degeneration and polypoid choroidal vascular disease are associated with the pathogenesis. The structure and function of choroidal vessels and the changes of choroidal venous blood flow dynamics may be caused by the disturbance of vortex vein circulation. Objective to evaluate the changes of choroidal hemodynamics in acute and chronic phase by establishing animal model of vortex vein ligation. And to evaluate the changes of choroidal vascular structure and function. Methods Eleven crab-eating monkeys were divided into three groups. One eye was randomly selected as experimental eye and the other eye as control group. The experimental eyes in group A were treated with ligation of 2 superior temporal quadrant and subtemporal quadrant vortex vein, only inferior temporal quadrant vortex vein was ligated. After laser induced CNV (choroidal neovascularization) model, two superior temporal and two infratemporal vortex veins were ligated to establish the animal model of vortex vein ligation. All patients were followed up for 12 weeks. Intraocular pressure measurement and slit lamp observation were performed on each eye before and after operation, three days before and once a week after operation. Each eye was examined by fundus color radiography (FPN), fluorescein fundus angiography (FFAA), indocyanine green fundus angiography (ICGAA) and coherence tomography (Oct) before operation, 1 day after operation, 1 week and 8 weeks and 12 weeks after operation. The ICG filling velocity and flow time of each image were compared and analyzed. The diameter of choroidal vessels was measured and analyzed by Image J software in ICGA images. Results the animal model of ligation of Vortex vein was successfully established, but the combination of laser induced CNV model and vortex vein ligation was not ideal. The intraocular pressure in the experimental group was significantly higher than that in the control group on the first day, 1 day and 2 day after operation. Anterior chamber exudation, anterior chamber hemorrhage and iris congestion were found in anterior segment ischemia within 1 week after operation. In group A, a large area of spot fluorescence leakage appeared on FFA and ICGA within 1 week after operation. 4 weeks after the operation, delayed or even no fluorescence filling occurred, and it became more obvious as time went on. Other monkeys showed no similar signs. One day after operation, the temporal choroidal vein filling delay was observed in the experimental eyes of group C, and returned to normal 1 week after operation. The absence of choroidal vein in the ligation quadrant of experimental eyes in group A was observed 4 weeks after operation (the incidence was 87.5% in group A and 50% in group C). At 12 weeks after operation, the diameter of choroidal vessels in the superior temporal quadrant of the experimental group was lower than that in the control group (P 0.05), but there was no significant difference between the experimental group and the control group at other time points. There was no statistical difference in the emptying time of ICG in each group. Oct examination showed that the choroid of the subtemporal quadrant was thicker than that of the superior temporal quadrant in group B within 1 week after operation. Conclusion the animal model of vortex vein ligation can be established successfully. Ligation of 1-2 vortex veins can cause choroidal circulatory disturbance in a short period of time. The long-term effect is compensatory change of choroidal circulatory system. The animal model of ligation of Vortex vein is more suitable for the study of choroidal circulatory disorders in acute stage.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R773.4

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