Objective To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy. Methods Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study. There were 11 males and 13 females. The age was ranged from 35 to 80 years, with the mean age of (56.7±15.6) years. There were 11 right eyes and 13 left eyes. The visual acuity was tested by standard visual acuity chart. The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA). The visual acuity was ranged from light sensation to 0.5, with the average of 0.04±0.012. The A-Rct was ranged from 18.0 s to 35.0 s, with the mean of (29.7±5.8) s. The FT was ranged from 4.0 s to 16.0 s, with the mean of (12.9±2.3) s. All patients were treated with urokinase intravenous thrombolytic therapy. The dosage of urokinase was 3000 U/kg, 2 times/d, adding 250 ml of 0.9% sodium chloride intravenous drip, 2 times between 8 - 10 h, and continuous treatment of FFA after 5 days. Comparative analysis was performed on the visual acuity of the patients before and after treatment, and the changes of A-Rct and FT. Results After intravenous thrombolytic therapy, the A-Rct was ranged from 16.0 s to 34.0 s, with the mean of (22.4±5.5) s. Among 24 eyes, the A-Rct was 27.0 - 34.0 s in 4 eyes (16.67%), 18.0 - 26.0 s in 11 eyes (45.83%); 16.0 - 17.0 s in 9 eyes (37.50%). The FT was ranged from 2.4 s to 16.0 s, with the mean of (7.4±2.6) s. Compared with before intravenous thrombolytic therapy, the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences (χ2=24.6, 24.9; P＜0.01). After intravenous thrombolytic therapy, the visual acuity was ranged from light sensation to 0.6, with the average of 0.08±0.011. There were 1 eye with vision of light perception (4.17%), 8 eyes with hand movement/20 cm (33.33%), 11 eyes with 0.02 - 0.05 (45.83%), 2 eyes with 0.1 - 0.2 (8.33%), 1 eye with 0.5 (4.17%) and 1 eye with 0.6 (4.17%). The visual acuity was improved in 19 eyes (79.17%). The difference of visual acuity before and after intravenous thrombolytic therapy was significant (χ2=7.99, P＜0.05). There was no local and systemic adverse effects during and after treatment. Conclusion Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.
ObjectiveTo compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.MethodsFrom January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using t-test.ResultsAt 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients. ConclusionsUrokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.
ObjectiveTo investigate the therapeutic effects of thrombolysis infusion via microcatheter on the treatment of central retinal artery occlusion(CRAO). MethodsUrokinase (UK) was directly infused via ophthalmic artery (OA) by microcatheter (6 patients) or via intravenous (7 patients) to dissolve the thrombus. The patency of the artery was evaluated by fundus fluorescein angiography (FFA), and the effect of fibrinolytic activity on the systemic changes was observed by blood biochemical examination simultaneously. ResultsIn 6 patients in the microcatheter group, 5 had completely and 1 had partly reopened OA on the morrow of UK infusion with the patency rate of 83.33%, while in 7 patients in vein group, 3 completely reopened, 2 partly reopened and 2 obstructed OA were found with the patency rate of 42.86%. The difference between the two groups was significant. No obvious change of index of blood coagulation system was found in catheter group, which had great disparity compared with the vein group.ConclusionUrokinase infusion via microcatheter in CRAO has better therapeutic impact and smaller effect on systemic action. (Chin J Ocul Fundus Dis, 2005,21:16-19)
PURPOSE:To investigate the relationship between the development of the diabetic retinopathy(DR)and the changes of ocular hemodynamics. METHODS:The hemodynamic parameters (Vmax,Vmin,RI)of central relinal artery(CRA )and central retinal vein(CRV)were measured both in the diabetes mellitus(DM) group(72 cases)and the control group(28 cases)with color Doppler flow imaging(Acuson-128XP/10). RESULT:The hemodynamic changes in CRA and CRV in the different stages of DR had their own characteristicS. The blood flow in CRA of the DM patients without DR was higher than that of the control (Plt;0.05). With tile deterioration of the retinopathy the blood flow in CRA decreased. The velocity of the blood flow in CRA of the proliferative DR group was less than that in the control ,DM without DR patients and background DR patients(Plt;0.05). The velocity of the flow in CRV of the DM patients was higher than that of control (Plt;0.001 )and exhibited its remarkable pulsative pattern. CONCLUSIONS:The changes of the hemodynamics in CRA.CRV was associated with the development of the diabetic retinopathy. （Chin J Ocul Fundus Dis,1997,13: 210-212 ）
Objective To observe the clinical features of combined central retinal artery and vein occlusion. Methods The clinical data of eight patients of combined central retinal artery and vein occlusion diagnosed by fundus examination and fundus fluorescein angiography (FFA) was analyzed retrospectively, including the causes, fundus manifestations and FFA features. Results 4/8 patients had hypertension and dyslipidemia, 2/8 patients had traumatic retrobulbar hemorrhage, one patient had orbital cellulitis and one patient had systemic lupus erythematosus. All the patients had posterior pole retinal edema, hemorrhage, thin retinal artery, dilated vein, and papilledema. FFA showed delayed arterial filling, and there was no filling of retinal arterial branches until the late stage of FFA. Laminar flow delayed in large retinal veins, and there was no filling or only retrograde filling in retinal vein branches. Large areas with dot-like or patchy weak choroidal fluorescence can be observed in five patients. Conclusions Combined central retinal artery and vein occlusion is rare with complex etiology. The fundus manifestations and FFA features are atypical, but have features of central retinal artery occlusion and central retinal vein occlusion.
Objective To investigate the effects of docosahexenoic acid (DHA) on large conductance Ca2+-activated K+ (BK) channels in normal retinal artery smooth muscle cells (RASMCs). Methods Cultured human RASMCs (6 th-8 th generations) were used to patch clamp experiment. The open probabihties (NP0) in BK channels with different concentrations (0.0, 1.0, 3.0, 5.0, 7.5, 10.0 μmol/L) of DHA were recorded by patch clamp technique in single channel configuration. RASMCs were intervened by different concentrations (0.0, 1.0, 5.0 μmol/L) of DHA as control group, low and high doses of DHA groups, respectively. The protein expressions of β subunit of BK channels in RASMCs from three groups were measured by Western blot. Results The NP0 of BK channels were 0.044 4±0.001 2, 0.081 2±0.004 2, 0.209 0±0.006 1, 0.310 5±0.005 3, 0.465 0±0.007 8 and 0.497 7±0.014 5 with perfusate of 0.0, 1.0, 3.0, 5.0, 7.5, 10.0 μmol/L DHA. DHA activated BK channels in a dose-dependent manner (F=2.621,P＜0.05). There was no significant difference in the protein expression of control group, low and high doses of DHA groups (F=11.657,P＞0.05). Conclusion DHA can directly activate BK channels, no increasing in subunit expression of BK channels.
Objective To observe the pathological changes of branch retinal artery occlusion (BRAO) by optical coherence tomography (OCT). Methods Twenty-six eyes of 26 patients with BRAO diagnosed in our Center from December 2002 to June 2005 were examined by OCT. The intervals of disease onsets and OCT examinations in all patients were within 2 weeks. The OCT scan modes were horizontal or vertical lines, and the locations of OCT scanning were macular area and the posterior pole of retina. The retinal thicknesses of macular foveola were measured and the macular thicknesses in different obstructive locations were compared using ANOVA analysis. The correlations of visual acuity and retinal thickness were analyzed by Pearson correlation analysis. Results Among the 26 eyes with BRAO, 9 eyes with temporosuperior artery occlusion, 8 eyes with temporoinferior artery occlusion, 7 eyes with arteriole occlusion and 2 eyes with retinal ciliary artery occlusion were observed. The pathological characteristics of OCT images of BRAO were increased retinal thickness and reflectivity in the obstructive locations, and widened dark area of photoreceptors (edema), while there was no obvious foveal edema were observed. The retinal images in other locations were normal. The average macular foveal thickness in the groups of temporosuperior artery occlusion, temporoinferior artery occlusion and retina arteriole occlusion were (161.11plusmn;17.66) mu;m, (148.38plusmn;18.48) mu;m and (136.29plusmn;14.94) mu;m, respectively (F=4.137,P=0.031,Pgt;0.01). There was no correlation of visual acuity with retinal thickness in 24 eyes (r＝0.285，P＝0.176，Pgt;0.01). Conclusion OCT could display the pathological changes of retinal tissue of BRAO in vivo. The increases of macular foveal thicknesses in BRAO eyes are not so obvious, and no correlations could be seen between visual acuity and macular foveal thickness. OCT is indicated on the old patients and the patients with systemic diseases for whom FFA is contraindicated. The unique characteristics of pathological changes of BRAO indicated by OCT images supply the objective signs for the instant clinical diagnosis. (Chin J Ocul Fundus Dis, 2007, 23: 173-176)
Objective To explore the short-term efficacy and safety of intra-arterial thrombolysis (IAT) in the treatment of retinal artery occlusion (RAO) with the assistance of the rescue green channel in the eye stroke center. Methods A prospective, interventional, single-center study. Thirty-eight eyes from 38 RAO patients who received IAT treatment in Guangdong Provincial People’s Hospital were enrolled. All the patients were rescued via the green channel in our eye stroke center. Data from comprehensive ocular examinations including best-corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) were collected. BCVA was measured with Snellen chart and converted to the logarithmic minimum angle of resolution (logMAR) unit for statistical analysis. RTVue XR OCTA was used to measure vascular densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary (RPC), and central retinal thickness (CRT). All RAO eyes attempted IAT treatment and 34 eyes were successful. Four eyes failed to complete IAT because of the occlusion of internal or common carotid arteries on the same side with the RAO eyes. Ocular examinations in post-operative 1-3 days were performed with the same devices and methods as those before surgery. Parameters measured before and after surgery include BCVA, VD of SCP, DCP, RPC, and CRT. Data of the green channel collected include the time intervals from onset of RAO to first presentation in local hospitals, and from onset of RAO to our eye stroke center. Comparisons of VD and CRT between the RAO eyes and contralateral healthy eyes were performed with independent samples Mann-Whitney U test; comparisons of VD and CRT in RAO eyes before and after IAT surgery were performed with paired samples Wilcoxon Rank Sum test. Results Among the 34 RAO patients who had successful IAT surgery, 18 (52.9%, 18/34) were males and 16 (47.1%, 16/34) were females; the mean age was (51.0±12.9) years old. There were 30 and 4 eyes diagnosed as central RAO and branch RAO respectively. The logMAR BCVA before and after IAT surgery was 2.52±0.61 and 2.18±0.85 respectively, and the difference was statistically significant (Z=－3.453, P=0.002). Before surgery, VD of SCP, DCP and RPC were significantly decreased and CRT was significantly increased in the affected eye compared with the contralateral healthy eyes, with the statistical significance (P＜0.001). Compared with those before surgery, the VD of SCP and DCP were significantly improved after surgery (Z=－2.523, －2.427; P=0.010, 0.014), while there was no difference in VD of RPC and CRT (Z=－1.448, －1.454; P=0.150, 0.159). The time interval between onset of RAO and first visit to the hospital was (6.56±6.73) hours; the time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early post-operative period and no cerebrocardiovascular events were observed later. he time interval between onset of RAO and the arrival at our hospital was (24.11±19.90) hours. No cerebral stroke was observed in the early post-operative period and no cerebrocardiovascular events were observed later. Conclusions The short-term efficacy and safety of IAT in the treatment of RAO were satisfactory. The rescue time window might be prolonged.
ObjectiveTo observe the clinical features of retinal arterial occlusion (RAO) in youth.MethodsThis is a retrospective case review. Nine patients (9 eyes) with RAO were enrolled in this study. There were 6 males (6 eyes) and 3 females (3 eyes). The average age was (14.22±3.93) years. The best-corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus color photography and fundus fluorescein angiography were performed. All patients underwent systemic evaluation including blood routine, erythrocyte sedimentation rate, blood lipids, vasculitis screening, homocysteine level, antiphospholipid antibody, blood coagulation, neck vascular ultrasound, and cardiac color ultrasound and electrocardiogram examination. All patients received oxygen therapy, blood medications and symptomatic treatment. Meanwhile, the patients with autoimmune diseases were received systemic glucocorticoid therapy. The follow-up was ranged from 6 to 12 months. The visual acuity and fundus change before and after treatment were compared.Resultsamong 9 patients, one patient had systemic lupus erythematosus, one patient had congenital heart disease, one patient had hypergammaglobulinemia, and carotid artery color ultrasonography showed that the internal carotid artery vessels faltered in 2 cases. The BCVA was 0.01 - 0.12. Among 9 eyes, there were 5 eyes (55.6%) with retinal branch artery occlusion (BRAO), 2 eyes (22.2%) with central retinal artery occlusion (CRAO), 2 eyes (22.2%) with ciliary retinal artery occlusion (CLAO). CRAO eyes showed positive RAPD (relative afferent pupillary defect), fine retinal artery and the corresponding vein, pale white retinal edema in posterior area and macular cherry-red spot. BRAO eyes manifested as inferior temporal artery occlusion and pale white retinal edema around them. CLAO eyes showed temporal ligulate grey-white retinal edema. At the last follow-up, BCVA improved and retinal vessels returned to normal in 7 eyes (77.8%); BCVA unchanged and no improvement in fundus in 2 eyes (22.2%).ConclusionAdolescent RAO is mostly partial occlusion, the prognosis is generally good after early active treatment.
Embolus occlusion in the retinal artery is the most common cause of central retinal artery occlusion (CRAO), while hypertension is the most common risk factor of CRAO, and ipsilateral carotid artery stenosis is the most significant risk factor in CRAO. Current clinical treatments include conservative treatments such as dilation of blood vessels and lowering the intraocular pressure (IOP), as well as aggressive treatments like intravenous thrombolysis and Nd:YAG laser. Both thrombolysis and Nd:YAG laser treatment can improve the visual acuity of CRAO patients, but because of its lack of randomized controlled trials, further clinical studies are needed to determine their efficacy and safety. CRAO patients may have vascular embolism at other sites in the body, and may cause different degrees of cardiovascular and cerebrovascular events. The probability of secondary ocular neovascularization following the occurrence of these events is 2.5% to 31.6%. In addition to eye care, clinicians should also focus more on preventing cardiovascular and cerebrovascular events, and focus on the screening and active treatment of systemic risk factors to reduce the incidence and mortality of cardiovascular and cerebrovascular events.