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 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 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)
ObjectiveTo evaluate the therapeutic effects of super-selective arterial catheterization with thrombolysis for central retinal artery occlusion (CRAO).MethodsThe clinical data of 16 patients with CRAO were collected. Aortic arch angiography with the catheterization through femoral artery firstly, and then the selective internal carotid artery angiography had been performed on all of the patients, including 12 ones who had undergone the urokinase thrombolysis therapy.ResultsIn the 16 patients, 3 with the severe straitness of the internal carotid artery and 1 with occlusion of incision of the ocular artery had not been treated by thrombolysis; and the others with occlusion of arterial trunk and CRAO had undergone thrombolysis therapy successfully. After the treatment, the visual acuity of the patients had improved in different degree and no systemic side effect had been found during the treatment.ConclusionsSuper-selective arterial catheterization with thrombolysis for CRAO may improve the visual acuity of the patients. The effects and risks of this treatment should be evaluated in further study.(Chin J Ocul Fundus Dis, 2005,21:20-21)
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)
Objective To investigate the therapeutic effects of throm bolytic drug infusion via carotid artery on experimental central retinal artery occlusion (CRAO), and observe the changes of fibrinolytic activity in the system ic circulation. Methods To dissolve the thrombi in 15 cats (30 eyes) with CRAO established by laser irradiating a branch of central retinal a rtery after intravenous injection of photochemical drugs, urokinase (UK) was dir ectly infused via carotid artery in 5 cats (10 eyes) in group A or intravenously injected in 5 cats (10 eyes) in group B, and isotonic saline solution was intra venously injected in 5 cats (10 eyes) in group C respectively. The patency of the artery was evaluated by fundus fluorescein angiography. Moreover, the changes of fibrinolitic activity in the blood were observed by blood biochemical examination. Results Four hours after UK infusion, the complete repatency proportion was 80% (5 cats 8 eyes) in group A, and 50% (4 cats 5 eyes) in group B. There was significant difference between the two groups. Besides, after the infusion, the indexes of coagulation, fibrinolysis, and anti-fibrinolysis in group A were better than those in group B and C (Plt;0.01). Conclusion In the treatment of experimental CRAO, thrombolytic drug infusion via carotid artery is better and more effective than via intravenous injection, which may provide a new method of thrombolytic drug delivery and animal models. (Chin J Ocul Fundus Dis，2004，20：186-188)
Purpose To analyze the relationship of retinal artery occlusion(RAO) with the white blood cell(WBC) count and inflammatory diseases away from the eyes. Methods Ninety-fours patients with retinal artery occlusion were studied retrospectively.The patients were divided into 2 groups,one of which with inflammatory diseases,the other without.An age and sex matched control group was made. Results Fifty four(58%) cases had inflammatory diseases of various causes at the same time,among which only 14(26%) cases directly involved the eyes.WBC count was significantly higher after the occurrence of RAO(Plt;0.05),comparing with that of the control group. Conclusion Inflammatory diseases away from the eyes may be oneof the factors causing RAO.The increased WBC count may be an inflammatory reaction to RAO. (Chin J Ocul Fundus Dis,1998,14:159-161)
ObjectiveTo observe the clinical effect of super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion (CRAO). MethodsTwelve CRAO patients (12 eyes) were enrolled in this study. The patients included 7 males and 5 females. The age was ranged from 19 to 68 years old, with an average of (50.0±3.5) years. The disease duration was from 8 to 72 hours, with a mean of 18 hours. All the patients were received the treatment of super-selective ophthalmic artery or selective carotid artery thrombolysis with urokinase (total 0.20-0.4 million U) and injection of papaverine 30 mg. Five patients received the treatment of super-selective ophthalmic artery thrombolytic therapy, 7 patients received the treatment of selective carotid artery thrombolytic therapy (4 patients because of the financial issues, 3 patients because of thin ophthalmic artery). According to the visual acuity of post-treatment and pre-treatment, the therapeutic effects on vision were defined as effective markedly (improving three lines or more), effective (improving two lines) and no effect (no change or a decline). According to the arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT) on fluorescence fundus angiography (FFA), the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct 15 s, FT 2 s), effective (A-Rct was improved but in the range of 16-20 s, FT was in 3-8 s) and no effect (A-Rct was improved but 21 s, FT 9 s). ResultsThe vision changes showed effective markedly in 5 eyes (41.7%), effective in 5 eyes (41.7%), no effect in 2 eyes (16.6%). The total therapeutic efficiency on vision was 83.4%. The retinal circulation was improved in all eyes after treatment, including effective markedly in 8 eyes (67.0%), effective in 4 eyes (33.0%). The total therapeutic efficiency on retinal circulation was 100.0%. No complications occurred in these 12 patients during the treatment or follow-up, such as puncture site hematoma, intracranial hemorrhage, cerebral embolism, eye movement abnormalities, retinal and vitreous hemorrhage. ConclusionSuper-selective ophthalmic artery and selective carotid artery thrombolytic therapy were effective in the treatment of CRAO.
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.
ObjectiveTo observe the clinical effect of the ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion (CRAO). MethodsFourteen CRAO patients (14 eyes) were enrolled in this study, including 8 males and 6 females. The age was ranged from 35 to 80 years old,with an average of (56.7±20.3) years. The duration of occurrence after the onset was 9 to 72 hours, with a mean of 22 hours. There were 4 eyes with vision of no light perception, 5 eyes with light perception and 5 eyes with hand movement. The intraocular pressure was ranged from 14-20 mmHg (1 mmHg=0.133 kPa), with an average of 19 mmHg. All the patients received the treatment of ophthalmic artery branch retrograde interventional therapy according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Micro catheters was inserted into the exposed arteries from a skin incision below the eyebrow under guidance of digital subtraction angiography (DSA), urokinase (total 0.4 million U) and papaverine 30 mg were injected into the arteries. After artery thrombolysis, the changes of DSA, filling time of retinal artery and its branches on fluorescence fundus angiography (FFA) within 48 hours and the visual acuity were observed. According to the visual acuity of post-treatment and pre-treatment, the therapeutic effects on vision were defined as effective markedly (improving 3 lines or more), effective (improving 2 lines) and no effect (change within 1 line or a decline). According to the arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT) on fluorescence fundus angiography (FFA), the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct 15 s, FT 2 s), effective (A-Rct was improved but in the range of 16-20 s, FT was in 3-8 s) and no effect (A-Rct was improved but 21 s, FT 9 s). The follow up ranged from 5 to 21days, with a mean of 6 days. The related local or systemic complications were recorded. ResultsOphthalmic arterial catheterization under DSA was successful in all 14 eyes. After intermittent injection of drugs, ophthalmic artery and internal carotid artery displayed good images in DSA. The results showed enlargement of ophthalmic artery and its branches after injection of thrombolytic drugs by micro catheters. The circulation time in ophthalmic artery is speed up for 2 s before thrombolysis in 5 eyes, 3 s in 6 eyes, and 4 s in 3 eyes. Within 48 hours after thrombolysis treatment, the filling time of retinal artery and its branches on FFA was significantly increased than that of before interventional therapy. The retinal circulation was effective markedly in 8 eyes (57.1%), effective in 4 eyes (28.6%) and no effect in 2 eyes (14.3%). The vision changes showed effective markedly in 6 eyes (42.9%), effective in 6 eyes (42.9%), no effect in 2 eyes (14.2%). There was no abnormal eye movements, vitreous hemorrhage and incision hematoma, intracranial hemorrhage, cerebral embolism, and other local and systemic adverse effectives during the follow-up. ConclusionsThe ophthalmic artery branch retrograde interventional therapy in the treatment for CRAO can improve retinal circulation and vision. And there is no related local or systemic complications.