摘要
目的 观察动静脉鞘膜切开术 (arteriovenous sheathotomy)治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)的临床疗效。 方法 分析 6例 BRVO患者经行睫状体平坦部玻璃体切割、玻璃体后皮质剥离、BRVO部位的动静脉鞘膜切开、动静脉分离等治疗的 6只患眼术中所见以及随访 3～ 12个月的视力、眼底彩色照相、荧光素眼底血管造影 (fundus fluorescein angiography,FFA)、光学相干断层扫描 (optical coherence tomography,OCT)、多焦视网膜电图 (multifocal electroretinography,m ERG)等检查的临床资料。 结果 手术中 ,切开动静脉鞘膜、分离动静脉时 ,均见近段静脉充盈增加。随访期间内 ,5例患者的视力显著提高 (最佳矫正视力为 1.5 ) ,眼底彩色照相、FFA检查发现视网膜出血明显吸收 ,血管变直 ,荧光素渗漏减少 ,但有 3例患者手术后 3个月在鞘膜切开部位的远段 FFA检查可见大片毛细血管闭塞区 ;OCT检查显示黄斑水肿较手术前大大减轻或消除 ;m ERG检查显示黄斑区反应振幅明显高于手术前。1例患者因反复玻璃体积血而再次手术。 结论 动静脉鞘膜切开术治疗 BRVO能提高患者视力 ,改善静脉回流 ,减轻黄斑水肿 。
Objective To evaluate the efficacy of arteriovenous sheathotomy on treatment of branch retinal vein occlusion (BRVO). Methods Six consecutive patients (6 eyes) with BRVO underwent par plana vitrectomy, posterios vitreous cortex separation, arteriovenous sheathotomy for BRVO. The follow up period was within 3～12 months. Postoperative examinations included color fundus photography, fundus fluorescein angiography(FFA), optical coherence tomography(OCT) and multifocal electroretinography (mERG). Results Increasing downstream blood flow in proximal past of compressed venule was promptly observed during the procedures of incision of the advential sheath of blood vessel, and separating and elevating the ateriole from the venule in all the operations in this series. Visual acuities improved postoperatively in 5 patients, and the best corrected visual acuity was 1.5. The examination of FFA showed obvious absorption of retinal hemorrhage, and leakage of dye was reduced, while large areas of capillary closure in retinas distal to the sheathotomy site were found 3 months after operation in 3 patients. OCT revealed disappearance or lightening of macular edema. mERG showed that the response amplitude of retina including the macular area was obviously higher after the operation. There was recurrent vitreous hemorrhage necessitating further surgery in one patient. Conclusion The operation of arteriovenous sheathotomy for the treatment of BRVO is much beneficial to improve patient′s visual acuity, downstream blood flow and macular affections, although the improvement of retinal reperfusion of the retina is not obvious.
出处
《中华眼底病杂志》
CAS
CSCD
2002年第1期6-9,共4页
Chinese Journal of Ocular Fundus Diseases
