【摘要】 目的 探讨医源性眼部血管阻塞的荧光血管造影(fundus fluorescein angiography，FFA)图像特征性表现。方法 对9例患者（9眼）进行荧光血管造影。结果 9例有明确医源性病史诱发的患者中4例为中央动脉阻塞，FFA表现为早期中央动脉静脉充盈迟缓，晚期视盘高荧光，黄斑周围毛细血管前微动脉充盈缺损；4例为中央动脉阻塞合并中央静脉阻塞，FFA表现为中央动静脉充盈迟缓，后极大量片状低荧光遮挡，黄斑拱环破坏，周围毛细血管前微动脉充盈缺损，后极及周边广泛无灌注区；1例为眼动脉阻塞，FFA表现为脉络膜背景荧光及中央动脉充盈迟缓，血管出视盘后荧光素充盈中断，至晚期不充盈，视网膜周边广泛无灌注区。结论 医源性眼部血管阻塞可引起中央动脉阻塞，中央动脉合并静脉阻塞及眼动脉阻塞，严重程度较重，阻塞范围较广，荧光血管造影表现有所不同，但发病原因、发病机制相似，在临床上应注意鉴别。
【关键词】 医源性眼部血管阻塞；荧光血管造影
FFA analysis of exogenous ocular vascular occlusion
ZHOU Hui,WANG Guang-lu,ZHANG Feng.
Department of Ophthalmology,Beijing Tongren Hospital,Beijing 100730,China
【Abstract】 Objective To explore the characteristic manifestation of FFA of exogenous vascular occlusion.Methods 9 eyes of 9 patients were photographed.Results Of 9 patients with exogenous medical history definitely，4 patients were diagnosed central retinal artery occlusion.FFA showed that central retinal artery and vein perfused slowly during early stage with filling defect of parafoveal arteriole before capillary，the optic disk showed hyperfluorescence during late stage.4 patients were diagnosed the central retinal artery occlusion with central retinal vein occlusion.FFA showed that central retinal vein perfused slowly，posterior pole has many pieces of hypofluorescence block，the foveal vascular arch was destroyed with filling defect of peripheral arteriole before capillary and there were extensive nonperfusion areas at the posterior pole and peripheral areas；1 patient was diagnosed ocular artery occlusion.FFA showed that choroidal background fluorescence and central artery were perfused slowly，the vascular fluorescence perfusion was interrupted before optic disk and the perfusion interruption continued until late stage with extensive peripheral nonperfusion areas.Conclusion Exogenous ocular vascular block can cause central retinal artery occlusion，central retinal artery occlusion with central retinal vein occlusion and ocular artery occlusion.These diseases are very severe and the block area is very extensive.Though manifestation of FFA is different，the etiology and mechanism are similar.It is very important to differentiate it from others in clinical.
【Key words】 exogenous ocular vascular occlusion;fundus fluorescein angiography
眼部血管阻塞是眼科危重急症，表现为急性视力丧失和视野缺损。我院对2002~2005年期间，有明确医源性病史诱发的9例视网膜中央动脉阻塞(CRAO)患者进行了荧光血管造影，现报告如下。
1 资料与方法
1.1 一般资料 9例患者中，男7例，女2例，年龄22~81岁，平均53岁，荧光血管造影时病程最短1天，最长1年余。视力光感~指数，均为单眼患者。9例患者中5例鼻腔术后，2例玻璃体切割术后，2例眶内肿物摘除术后。见表1。表1 一般资料
1.2 检查仪器 荧光眼底血管造影：采用TOPCON眼底照相机进行常规造影检查。
2 结果
2.1 中央动脉阻塞 4例患者，视力:光感~二尺指数，术后2天~1个月余，眼底表现为视盘苍白1例、水肿3例，边界清楚3例、不清1例，动脉细、僵直，黄斑典型的樱桃红1例，未见樱桃红3例，视网膜灰白色水肿。FFA表现为早期：视网膜中央动脉均充盈迟缓，动脉前期最短10″9，最长43″7，平均28″9。视网膜动脉完成充盈循环时间最短23″4，最长3′44″5，平均1′22″8。静脉亦充盈迟缓，静脉出现层流的时间最短23′4，最长1′59″7，平均54″5。其中1例视网膜静脉呈现逆行充盈现象。晚期：4例造影片中均可见视盘高荧光，黄斑周围毛细血管前微动脉充盈缺损(见图1)。
2.2 中央动脉阻塞合并中央静脉阻塞 4例患者，视力:无光感~眼前指数，术后1~3个月余，眼底表现为视盘颜色淡，边界清楚，其中1例视盘周围大量棉絮斑，视网膜动脉僵直狭窄，管径不均或呈白线状，静脉迂曲扩张，未见樱桃红，视网膜广泛出血。FFA表现为早期：视网膜中央动脉充盈迟缓，动脉前期最短14″2，最长18″3，平均16″2。视网膜动脉完成充盈循环时间最短23″4，最长至晚期仍不充盈。静脉出现层流的时间最短20″3，最长28″2，平均24″1。后极部大片无灌注区。晚期：视盘高荧光1例，后极部散在片状低荧光4例，玻璃体荧光渗漏1例(见图2)。
2.3 眼动脉阻塞 1例患者，视力：眼前手动，右鼻息肉术后3个月行FFA。眼底表现为视盘呈色素增殖性黑色，边界不清，动脉和静脉均呈节段性白线状，后极网膜下灰白色瘢痕。其FFA表现为早期：脉络膜背景荧光充盈迟缓(13″5开始充盈)，中央动脉充盈迟缓(15″5开始充盈)，视盘附近大血管略有充盈，出视盘后很快中断，至晚期仍不充盈，晚期：视网膜周边广泛无灌注区，视盘、黄斑稍有渗漏(见图3)。
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