The characteristics of nonarteritic anterior ischemic optic neuropathy (NAION) include sudden decline of visual acuity, sectorshaped visual field defect connected with the physiological blind spot or hemivisual field defect, and optic disc edema.Early angiographic abnormalities of optic disc and peripapillary choroidal circulation are important cues for the diagnosis. Angiography combined with visual field test can make the diagnosis more accurate. The pathological mechanism and process of NAION and ischemic cardiovascular/cerebrovascular disease are essentially the same. There are several critical issues in this field we need focus on,including strengthening the cooperation with relevant professional disciplines; improving the ocular ischemia through drugs, intervention and other means; preventing more serious cardiovascular events and intervening in a number of highrisk populations to reduce the incidence of AION.
Objective To evaluate the clinical effect of Nd:YAG laser embolysis combined urokinase thrombolysis therapy for branch retinal artery occlusion. Methods Thirty-four eyes of 34 patients with branch or hemiretinal artery occlusion (RAO) were studied. All patients were confirmed according to the diagnosis criteria of RAO at acute stage, disease course ranged from 12 hours to nine days. Local retinal edema and the yellowish white embolus within the retinal arteriole could be observed by color photograph and fundus fluorescein angiography (FFA) examination. Nd:YAG laser therapy was given to all eyes, which focused on the embolus by an ocular contact lens. The laser pulse was delivered directly and gradually by 0.3-0.9 mJ according to embolus condition. Fundus photographs and FFA were taken before and immediately after the laser treatment. On the next day after laser treatment, all patients received urokinase thrombolysis therapy through intravenous drip of 100 000200 000IU per time by two times for five consecutive days. Follow-up time ranged from two to three days after drug treatment and all patients accepted FFA, visual acuity and visual field examination. According to early angiography images of fluorescence filling, the recovery will be graded into full recovery, great recovery, partial recovery and invalid. Results After laser treatment, most eyes showed immediate recovery of blood flow in the occluded arteriole in fundus examination. Complete, great, and partial recovery were found in 13 eye (38.2%), 11 eyes (32.4%), and five eyes (14.7%) respectively by FFA examination; five eyes (14.7%) did not response to the treatment. After urokinase thrombolysis therapy, complete, great, and partial recovery were found in 16 eye (47.1%), 15 eyes (44.1%), and three eyes (8.8%). The difference of visual acuity was statistically significant before and after the combined treatment (chi;2=30.7,P＜0.05). In most cases, visual field defect showed lighter than before. No systemic complications were observed during the combined treatment. Conclusion Nd:YAG laser embolysis combined urokinase thrombolysis therapy for branch retinal artery occlusion is effective and relatively safe.
Objective To investage the relationship among the visual loss, the disease course, and retinal circulation time in patients with central retinal artery occlusion (CRAO)． Method The data about the central vision, disease course, and results of fundus fluorescein angiography (FFA) of 99 patients (99 eyes) with CRAO were statistically analyzed. Results Between 2 days and 21 days after the occurrence of CRAO, the disease course didnrsquo;t relate to the central visual loss (Pgt;0.05). In the retinal circulation, a correlation was found between the time of fluorescein perfusion and the central visual loss (Plt;0.05) but not between the time of arm-retina circulation and the central visual loss (Pgt;0.05). Conclusion In the duration of retinal circulation, the time of fluorescein perfusion in retinal artery relates to the central visual loss; the longer the duration is, the worse the vision is. (Chin J Ocul Fundus Dis, 2007, 23: 177-179)
Objective To evaluate the effective method for treatment of premacular hemorrhage. Methods In 36 cases (36 eyes) of premacular hemorrhage (2PD),25 cases were treated with medicine, and 11 cases were treated with laser surgery and medicine. Results In 25 patients treated with medicine, the average time of vision recovery was 24 days and the average time of clearance of vitreous hemorrhage was 40 days; in the other 11 patients treated with laser surgery and medicine,10 were treated successfully, and in these 10 patients, the average time of vision recovery were 5 days and the average time of clearance of premacular hemorrhage were 11 days in 10 cases which were operated successfully with laser in 11 cases. Conclusions Laser surgery of inducing preretinal hemorrhage to vitreous body is an effective method for treatment of premacular hemorrhage to relieve the impaired central vision. (Chin J Ocul Fundus Dis, 2002, 18: 199-201)
ObjectiveTo observe the cilioretinal artery and its relationship with central visual loss in central retinal artery occlusion(CRAO) patients. MethodsA total of 140 CRAO patients (140 eyes) were enrolled in this study. The patients included 83 males and 57 females. The age was ranged from 42 to 75 years old, with an average of (55.70±22.20) years. All the patients were affected unilaterally, including 79 right eyes and 61 left eyes. The disease duration was from 1 to 10 days, with a mean of (4.7±3.9) hours. Central vision and fluorescence fundus angiography were measured for all patients. The central visual loss was divided into 3 types: mild (≥0.1), moderate (finger counting to 0.08) and severe (no light perception to hand movement). The number, length and location of cilioretinal artery were observed. The correlation between cilioretinal artery and central visual loss was analyzed. ResultsThere were 41 eyes (29.3%) with cilioretinal artery, which including 13 eyes (31.7%) with ≥3 cilioretinal arteries, 23 eyes (56.1%) with 2 cilioretinal arteries, 5 eyes (12.2%) with 1 cilioretinal arteries. The cilioretinal artery was within 1 disk diameter (DD) in length and not reached the macular area in 37 eyes (90.2%), was more than 1DD in length and reached the macular foveal area in 4 eyes (9.8%). The cilioretinal artery located in the temporal side of optic disk in 29 eyes (70.7%), and in other quadrant in 12 eyes (29.3%). The distribution of central visual loss degree as follow: mild in 15 eyes (10.7%), moderate in 50 eyes (35.7%), severe in 75 eyes (53.6%). The difference of central visual loss in the eyes with or without cilioretinal arteries was not significant (χ2=0.16, P>0.05). ConclusionsCilioretinal artery exists in 29.3% CRAO eyes. There was no close correlation between cilioretinal artery and central visual loss.
Objective To observe the digital subtraction angiography (DSA) characteristics of ophthalmic artery and its main branches in ischemic cerebrovascular disease (ICVD). Methods The internal carotid arteries, external carotid arteries and ophthalmic arteries of 32 ICVD patients were examined for DSA. The characteristics of ophthalmic artery origin, trail and main branches were observed. Results Among 64 carotid arteries of 32 patients, there was one carotid artery with internal occlusion, there was no severe stenosis in the other 63 carotid arteries. The 63 ophthalmic arteries originated all from supraclinoidal and ophthalmic segments of internal carotid arteries. 58 ophthalmic arteries were single branch from the internal carotid artery. 5 ophthalmic arteries had 2 branches, one come from the internal carotid artery, the other come from the middle meningeal artery (external carotid artery branch ) in 4 cases or from the anterior cerebral artery (carotid artery branch) in 1 case. The main branches of ophthalmic artery included central retinal artery, posterior ciliary artery, lacrimal gland artery, ocular muscular artery; anterior ethmoid artery, posterior ethmoid artery, supraorbital artery, dorsal nasal artery, supratrochlear artery and eyelid artery. The beginning point of each branches were variable. Conclusions Ophthalmic arteries of ICVD patients primary arise from the internal carotid artery. It most often appears as single branch and occasionally as double branches. The beginning points of major branches of ophthalmic artery are variable.