作者：周朝晖，汤宪辉，王 贞，陆 莹，易省平，华 芸，黄朝婷
作者单位：（330006） 中国江西省南昌市，北京同仁江西眼科医院
【摘要】 目的：探讨视乳头切开术治疗缺血性视网膜中央静脉阻塞的临床疗效。
方法：缺血性视网膜中央静脉阻塞患者12例。术前患者均行眼底照相、荧光素眼底血管造影（FFA）检查。手术常规做玻璃体切割，应用显微玻璃体视网膜切开刀，以鼻侧视乳头边缘为中心，垂直刺入达最宽处为止。术后1，3，6mo行眼底照像、FFA检查。
结果：术中，视乳头切开后均可见视盘近端视网膜静脉充盈增加，9例术中穿刺时有少量出血，未经特殊处理均很快停止，1例术中发生局限性视网膜下出血。术后1mo内，11例患者视网膜或黄斑水肿均减轻或消退。术后3mo，患者行眼底照像、FFA检查结果均显示视网膜出血吸收，黄斑水肿消退；10例视力较术前提高（80%）。1例保持不变，1例术中发生局限性视网膜下出血者术后视力下降。
结论：视乳头切开术是安全有效的手术，有助于视网膜内出血、渗出及黄斑水肿的消退，部分患者视力可得到改善。
【关键词】 视网膜中央静脉阻塞；视乳头切开术
Radial optic neurotomy for 12 case of central retinal vein occlusion
Zhao-Hui Zhou, Xian-Hui Tang, Zhen Wang, Ying Lu, Sheng-Ping Yi, Yun Hua, Zhao-Ting Huang
Beijing Tongren Eye Hospital of Jiangxi , Nanchang 330006, Jiangxi Province, China
Abstract AIM: To investigate the surgical effect of radial optic neurotomy for ischemic central retinal vein occlusion (CRVO). METHODS: Twelve consecutive patients (12 eyes), preoperative examination including color fundus photography, fundus fluorescein angiography, underwent parplana itrectomy, A microvitreoretinal(MVR) blade was used to relax the scleral ring and adjacent sclera of nasal aside of the optic disk, The depth of the incision into the optic nerve placed the MVR blade just beyond the widest portion of the diamond-shaped tip . The follow-up period was 1, 3, 6 months, and postoperative examination including color fundus photography, fundus fluorescein angiography were performed. RESULTS: Radial optic neurotomy was performed in all 12 patients successfully. The retinal vein permeation increased were found after optic neurotomy in all patients , and the small hemorrhage in 9 patients, subretinal local hemorrhage in 1 patient was noted during the surgical procedure, and 11 patients had improve in the retina and macular edema and the appearance of the fundus in 1 month postoperatively and the retinal hemorrhage was significantly absorbed and macular edema disappeared in 3 months postoperatively as documented by photography , fluorescein angiography. Postoprative visual acuities were improved in 10 of 12 of patients (80%) and the visual acuities were not improved in 1 patient and the visual acuities were decreased in 1 patient with subretinal local hemorrhage.CONCLUSION: Radial optic neurotomy is a safe and effective operation and may improve the retinal hemorrhage, retinal exude, macular edema and the visual acuity prognosis in patients with ischemic CRVO.
· KEYWORDS: central retinal vein occlusion; radial optic neurotomy
周朝晖,汤宪辉,王贞,陆莹,华芸,黄朝婷.视乳头切开术治疗视网膜中央静脉阻塞12例报告.国际眼科杂志,2007;7(3):718-719
0引言
视网膜中央静脉阻塞是一种严重威胁视功能的视网膜血管病，是继糖尿病视网膜病变后的第2位致盲性眼底疾病，目前临床上仍无特效治疗方法。2001年Opremcak等[1]尝试应用放射状视神经切开术治疗视网膜中央静脉阻塞,取得较好效果。我们于2004-01/2007-01间，对12例CEVO患者的12只患眼采用了视乳头切开术进行治疗，现将结果报告如下。
1对象和方法
1.1对象 FFA检查确诊的缺血性视网膜中央静脉阻塞患者12例，男8例，女4例，年龄34～73（平均53）岁。病程1～10（平均5.5）mo。患者术前视力范围在手动/眼前～0.2，手术前均无激光治疗史。除了常规、系统的眼科检查以外，12例患者术前还进行了FFA检查、眼底彩照、ERG等特殊检查，眼底彩照可见眼底各象限明显火焰状出血，静脉显著迂曲扩张，FFA检查发现各象静脉回流时间明显延长，迂曲扩张，大片视网膜出血遮蔽荧光，晚期黄斑水肿。MERG检查发现：视网膜广泛性反应呈降低和延迟，黄斑区振幅明显降低。
1.2方法 所有患者经睫状体平坦部玻璃体切割，剥离玻璃体后皮质，提高眼内压以减少出血，然后在视盘的鼻侧（选择鼻侧视盘是为了避免伤黄斑视乳头的神经纤维），避开主要的血管，以视乳头鼻侧缘无血管处作平行于神经纤维层走向的放射状切口，将巩膜刀置于视盘的边缘，沿视盘边缘为中心垂直刺入，刺入深度约2.2mm（达切开刀最宽处为止），宽度约1.2mm;缓缓退出玻璃体视网膜切开刀,缝合巩膜三切口及结膜切口。术中，视乳头切开后均可见视盘近端视网膜静脉充盈增加，9例术中穿刺时有少量出血，未经特殊处理均很快停止，1例术中发生局限性视网膜下出血。术中对10例患者行阻塞区域的视网膜光凝。手术后随访6~16mo。分别在手术后1d；1，3，6mo及末次随访时行眼底彩照，FFA和ERG等检查。以观察视网膜出血的吸收、黄斑区水肿改善及无灌注区的改善情况。
2结果
2.1视力 术后最佳矫正视力：0.02～0.8，10例视力较术前提高（80%），1例术中发生局限性视网膜下出血者由术前0.1下降至术后0.02。
2.2对比术前术后的眼底彩照、FFA和ERG 等检查结果 术后1mo内，11例患者视网膜或黄斑水肿均减轻或消退。术后3mo，患者行眼底照像、FFA检查结果均显示视网膜出血吸收，黄斑水肿消退；视网膜出血明显吸收，静脉回流改善，血管变直。
2.3并发症 该手术主要的并发症为出血，少量的出血提高眼内压以后出血可自行停止，有1例患者因术中发生严重的视网膜下出血行硅油填充术，术后3～6mo内视网膜下出血吸收。
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