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視網膜枝靜脈阻塞的臨床觀察
Clinical Observations on Retinal Branch Vein Occlusion
摘要
本篇收集近四年於台大眼科視網膜特別門診追踪治療之網膜枝靜脈阻塞病患50名，平均追踪9個月。分析其臨床資料、螢光眼底攝影及生化檢查。年齡平均56.4歲，男與女之比為3比2，均單眼受犯，視力大於等於0.5者佔35.3%，0.4至0.2者佔29.4%，小於0.1者佔35.3%，高血壓患者佔84%，糖尿病患者佔25%。文中統計及討論阻塞之部位、分枝、無灌流區、側循環之建立、黃斑部受犯及水腫、新生血管及併發症與視力之關係。有持續性黃斑部水腫及無灌流區大於5個視神經盤直徑者終視力較差。血液生化學檢查包括ESR、CRP、rGT等則無明顯異常。
關鍵字
無資料並列摘要
A retrospective study of 50 patients with retinal branch vein occlusion is presented. The disease occurred mainly in aged people with hypertension or diabetes. There was no special tendency involving male or female as well as right eye or left eye. The diagnosis could generally be determined by fundoscopy and fluoroscence angiography examinations of the typical changes in both acute and chronic stages of the disease. However, sometimes the changes were subtle after the absorption of the intraretinal hemorrhage, and misciagnosises were not infrequent. This was especially true in cases involving macular branch vein occlusion. The visual prognosis was fair. About 1/3 to 1/2 of the affected eyes maintained 20/40 or better vision. (In this paper, it was 35.5%). Visual acuity was mainly affected by (1) Macular edema (2) Non-perfusion area. Though macular edema was reversible in the acute stage, persistent and chronic macular edema affected the central vision directly and permanently. Wide spread (＞5 D.D.) non-perfusion area might set the stage for the development of neovasularization and consequently vitrous hemorrhage, which could be disastrous to final vision. Non-perfusion or vascular closure of the foveal capillary ring might lead to ischemic macular edema and the visual prognosis was guarded. The development of collateral circulation was not a proof of good final vision. Aside from macular edema and vitrous hemorrhage, other complications found, were traction retinal detachment (1 case), rhegmatogenous retinal detachment (1 case), macular pucker (1 case). Elevated intraocular pressure (2 cases) played less of a role in this disease than in central retinal vein occlusion. The role of arteriolar diseases and venous pathologies in the pathogenesis of the disease remaines to be clarified. Although serum protein, lipid as well as C-reactive protein and ESR value were reported to be significantly abnormal in BRVO patients, and blood viscosity change or increased inflammatory change was implicated as contributing to this disease, it could not be verified in this paper. The encouraging results in treating the BRVO patients with macular edema were obtained in the BRVO study group. Further evaluations of other treatment modalities are needed.