本文選題：視網膜中央靜脈阻塞 + 黃斑水腫��； 參考：《河北醫(yī)科大學》2011年碩士論文

【摘要】：目的:視網膜中央靜脈阻塞(central retinal vein occlusion,CRVO)是臨床常見的視網膜血管疾病,也是臨床最常見的致盲眼病之一。CRVO又可分為兩型,即缺血型(ischemic)與非缺血型(nonischemic)。缺血型CRVO較非缺血型CRVO預后差,其原因是缺血型CRVO的患者眼底存在不同程度的毛細血管無灌注區(qū),導致視網膜新生血管生成,新生血管易反復出血,血液進入玻璃體后沉積機化牽拉視網膜造成牽拉性視網膜脫離;部分患者可出現虹膜新生血管進而演變?yōu)殡y治的新生血管性青光眼(neovascular glaucoma,NVG);黃斑的持續(xù)缺血造成黃斑水腫導致患者視物變形,視力嚴重下降。玻璃體切除聯合內界膜撕除、全視網膜光凝及玻璃體腔注射曲安奈德為近年來新興的治療缺血型CRVO的手術方法,本研究旨在觀察此種術式的臨床療效及探討其可能出現的并發(fā)癥及作用機制,為臨床應用提供參考。 方法:選擇2010年11月至2011年2月于河北醫(yī)科大學第二醫(yī)院眼科就診的缺血性視網膜中央靜脈阻塞的患者6例6只眼,全部眼行玻璃體切除聯合內界膜撕除、全視網膜光凝及玻璃體腔注射曲安奈德4mg手術治療。于治療后1、2、3天、1周、1個月檢查視力及最佳矯正視力,于治療后3天、1周、1個月行眼壓測量,于治療后1、2、3天、1周、1個月行常規(guī)眼前節(jié)及眼底檢查,于治療后1個月復查FFA并行眼底彩色照相,治療后1星期、1個月時復查OCT并與術前對比。 結果 1符合入選標準患者6例6只眼,失訪1例1只眼。最后入選5例5只眼,隨訪終末5只眼中4只眼較術前BCVA提高。 2所有入選眼術前眼壓均在9~21mmHg范圍內,隨訪終末5只眼中2只眼眼壓較術前升高,3只眼較術前降低,但所有眼眼壓均21mmHg。 3手術治療前所有入選患者患眼虹膜均未發(fā)現新生血管,手術治療后3天內均未發(fā)現角膜混濁水腫,隨訪結束時所有眼均未發(fā)現虹膜新生血管。 4隨訪終末所有眼眼底檢查均可見視網膜出血有不同程度的吸收,靜脈迂張減輕,4只眼黃斑水腫減輕,1只眼黃斑水腫未減輕。 5隨訪終末5只眼中4只眼CMT較術前降低,其中降低幅度最大者為630μm;1只眼CMT升高且高于術前,考慮為黃斑水腫復發(fā)。 6隨訪終末4只眼FFA早期及中晚期視盤及血管熒光滲漏較術前減少,視盤及黃斑區(qū)水腫減輕,靜脈迂張較術前減輕。1只眼黃斑水腫未減輕。 7術中及術后未發(fā)現相關并發(fā)癥發(fā)生。 結論: 1 PRP+PPV+ILM peeling+IVTA4mg治療缺血型CRVO的療效值得肯定。 2 PRP+PPV+ILM peeling+IVTA4mg對改善黃斑水腫及促進視網膜出血吸收的效果易見。 3 PRP+PPV+ILM peeling+IVTA4mg的長期療效及遠期并發(fā)癥尚需大樣本的長期隨訪觀察。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R774.1

【參考文獻】

相關期刊論文 前1條

1 劉鐵城,王煒,金鑫,黃一飛,張卯年;玻璃體內注射曲安奈德治療視網膜中央靜脈阻塞引起的黃斑囊樣水腫[J];中華眼底病雜志;2005年04期

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本文編號：2104418