玻璃体切除联合内界膜撕除、全视网膜光凝及玻璃体腔注射曲安奈德治疗缺血型视网膜中央静脉阻塞的临床疗效观察

发布时间：2018-07-07 08:43

本文选题：视网膜中央静脉阻塞 + 黄斑水肿　；参考：《河北医科大学》2011年硕士论文

【摘要】：目的:视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)是临床常见的视网膜血管疾病,也是临床最常见的致盲眼病之一。CRVO又可分为两型,即缺血型(ischemic)与非缺血型(nonischemic)。缺血型CRVO较非缺血型CRVO预后差,其原因是缺血型CRVO的患者眼底存在不同程度的毛细血管无灌注区,导致视网膜新生血管生成,新生血管易反复出血,血液进入玻璃体后沉积机化牵拉视网膜造成牵拉性视网膜脱离;部分患者可出现虹膜新生血管进而演变为难治的新生血管性青光眼(neovascular glaucoma,NVG);黄斑的持续缺血造成黄斑水肿导致患者视物变形,视力严重下降。玻璃体切除联合内界膜撕除、全视网膜光凝及玻璃体腔注射曲安奈德为近年来新兴的治疗缺血型CRVO的手术方法,本研究旨在观察此种术式的临床疗效及探讨其可能出现的并发症及作用机制,为临床应用提供参考。方法:选择2010年11月至2011年2月于河北医科大学第二医院眼科就诊的缺血性视网膜中央静脉阻塞的患者6例6只眼,全部眼行玻璃体切除联合内界膜撕除、全视网膜光凝及玻璃体腔注射曲安奈德4mg手术治疗。于治疗后1、2、3天、1周、1个月检查视力及最佳矫正视力,于治疗后3天、1周、1个月行眼压测量,于治疗后1、2、3天、1周、1个月行常规眼前节及眼底检查,于治疗后1个月复查FFA并行眼底彩色照相,治疗后1星期、1个月时复查OCT并与术前对比。结果 1符合入选标准患者6例6只眼,失访1例1只眼。最后入选5例5只眼,随访终末5只眼中4只眼较术前BCVA提高。 2所有入选眼术前眼压均在9~21mmHg范围内,随访终末5只眼中2只眼眼压较术前升高,3只眼较术前降低,但所有眼眼压均21mmHg。 3手术治疗前所有入选患者患眼虹膜均未发现新生血管,手术治疗后3天内均未发现角膜混浊水肿,随访结束时所有眼均未发现虹膜新生血管。 4随访终末所有眼眼底检查均可见视网膜出血有不同程度的吸收,静脉迂张减轻,4只眼黄斑水肿减轻,1只眼黄斑水肿未减轻。 5随访终末5只眼中4只眼CMT较术前降低,其中降低幅度最大者为630μm;1只眼CMT升高且高于术前,考虑为黄斑水肿复发。 6随访终末4只眼FFA早期及中晚期视盘及血管荧光渗漏较术前减少,视盘及黄斑区水肿减轻,静脉迂张较术前减轻。1只眼黄斑水肿未减轻。 7术中及术后未发现相关并发症发生。结论: 1 PRP+PPV+ILM peeling+IVTA4mg治疗缺血型CRVO的疗效值得肯定。 2 PRP+PPV+ILM peeling+IVTA4mg对改善黄斑水肿及促进视网膜出血吸收的效果易见。 3 PRP+PPV+ILM peeling+IVTA4mg的长期疗效及远期并发症尚需大样本的长期随访观察。
[Abstract]:Objective: central retinal vein occlusion (CRVO) is a common clinical retinal vascular disease, and is one of the most common clinical blindness diseases..CRVO can be divided into two types, namely, the deficiency of blood type (ischemic) and non deficient blood type (nonischemic). The prognosis of ischemic CRVO than that of non deficient blood type CRVO is poor, and its reason is the CRVO of the blood type. There are different degrees of capillary instillation in the fundus of the patients, which leads to the formation of neovascularization of the retina, the revascularization of the neovascularization and the traction retinal detachment caused by the blood entering the vitreous, and the neovascularization of the iris in some patients and then the refractory neovascular glaucoma (neovascul Ar glaucoma, NVG); the continuous ischemia of macula causes macular edema to cause visual deformation and severe visual loss. Vitrectomy combined with internal boundary membrane avulsion, retinal photocoagulation and intravitreal injection of Cu Ann Ned as a newly emerging surgical method for the treatment of blood deficiency type CRVO in recent years. This study aims to observe the clinical efficacy and exploration of this type of operation. To discuss the possible complications and the mechanism of action, so as to provide reference for clinical application.
Methods: 6 eyes of 6 patients with ischemic retinal central venous obstruction from November 2010 to February 2011 at the second hospital of Hebei Medical University were selected. All eyes were treated with vitrectomy combined with internal boundary membrane avulsion, all retinal photocoagulation and vitreous cavity injection of Cu Ann Ned 4mg. After 1,2,3, 1, and 1 months after treatment Visual acuity and best corrected visual acuity were measured at 3 days, 1 weeks and 1 months after treatment. Routine anterior and ocular fundus examinations were performed at 1,2,3 days, 1 weeks and 1 months after treatment. FFA parallel fundus color photography was rechecked for 1 months after treatment, and OCT was reviewed at 1 months after treatment and compared with preoperative.
Result
1 there were 6 cases of 6 eyes conforming to the inclusion criteria, 1 cases of 1 eyes missing, and 5 cases of 5 eyes. The follow-up of 5 eyes showed that 4 eyes were higher than those of BCVA before operation.
2 the intraocular pressure of all the selected eyes was within the range of 9~21mmHg. The intraocular pressure of 2 eyes in the 5 eyes of the final follow-up was higher than that before the operation, and 3 eyes were lower than the preoperative, but all eye pressure was 21mmHg.
No neovascularization was found in all the ocular iris of all the patients before surgical treatment. Corneal opacification and edema were not found within 3 days after surgical treatment. No neovascularization of the iris was found in all eyes at the end of the follow-up period.
4 all ocular fundus examination at the end of the end of follow-up showed that retinal hemorrhage had different degrees of absorption, venous circuitous reduction, 4 eyes with macular edema and 1 eyes with macular edema.
5 in the 5 eyes of the final follow-up, 4 of the 5 eyes were lower than that of CMT before operation, the largest reduction was 630 m, 1 eyes were higher and higher than those before operation, and the recurrence of macular edema was considered.
6 in the final 4 eyes of the end of follow-up, the optic disc and blood vessel fluorescein leakage in the early and middle stage of FFA decreased, the edema of the optic disc and macular area decreased, and the venous detour was less than that of.1 eyes.
7 intraoperative and postoperative complications were not found.
Conclusion:
The efficacy of 1 PRP+PPV+ILM peeling+IVTA4mg in the treatment of ischemic CRVO is worth affirming.
2 PRP+PPV+ILM peeling+IVTA4mg is more effective in improving macular edema and promoting retinal hemorrhage absorption.
The long-term efficacy and long-term complications of 3 PRP+PPV+ILM peeling+IVTA4mg need large sample long-term follow-up observation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774.1

【参考文献】