葡萄膜病DISEASEOFTHEUVEA培训教材.pptVIP

治疗：视网膜对缺氧极为敏感，一旦发生供血中断，应在短时间内尽早抢救以挽回部分视力。（1）急诊处理： 扩张视网膜动脉缓解痉挛；2）后期处理：急诊处理后，视功能有所恢复时，继续口服血管扩张剂。此外，各种支持药如维生素类，ATP，辅酶A均可应用。 预后：取决于阻塞部位、程度和时间。 retinal vein occlusion Retinal vein occlusion is a common fundus disease; its causes are extravascular compression, stagnation of venous blood stream as well as impairment of venous vascular inner wall. Extravascular compression is most caused by sclerosis of the central retinal artery or its branches within the optic nerve or at the arteriovenous crossing to compress its neighbor veins. So, it is commonly seen in the elder with hypertension and arteriosclerosis. Stagnation of venous blood stream is seen in the cases with insufficient perfusion pressure or increased intraocular pressure or high blood viscosity. So it is often complicated by insufficient blood supply of the carotid, a large quantity of blood loss, lower intraocular pressure, glaucoma,erythrocytosis, diabetes, sickle cell anemia and abnormal albumen in the blood and other diseases. Impairment of vascular inner wall is often caused by trtinal vasculitis, so it is commonly seen in the young and diabetic patients. 视网膜中央静脉栓塞（central retinal vein occlusion，CRVO） 较CRAO常见。病因：血管外压迫，静脉血流淤滞，静脉管壁损害。 临床表现：有视网膜中央静脉阻塞及分支阻塞两种类型。总干阻塞多位于视乳头筛板区或筛板后区的总干，视网膜静脉粗大、迂曲，血管呈黯红色；视网膜呈现大量的火焰状出血，静脉管壁的渗漏引起视网膜广泛的水肿，视网膜静脉呈断续状埋藏于水肿的视网膜内；严重者可见棉绒斑及视乳头水肿。 分支阻塞（branch retinal vein occlusion）较总干阻塞为常见，多见于高血压、动脉硬化的老年人。常为颞上或颞下支栓塞。 荧光血管造影对CRVO的诊断、治疗尤其是分型极重要。早期静脉荧光回流缓慢，充盈时间延长，分支阻塞者可显示出阻塞的部位。阻塞区毛细血管明显扩张，造影后期可见毛细血管有明显的荧光渗漏。 Clinicallly, according to the different sites of occlusion, it is divided into central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). 治疗：抗凝①纤维蛋白溶解酶：包括尿激酶、链激酶、纤维蛋白溶酶、蛇毒抗栓酶等。其中尿激酶无抗原性，使用前不必作过敏试验，毒性作用较小，故最常用。 ②抗血小板凝集剂：常用有乙酰水杨酸肠溶片及番生丁。 中药治疗：活血化瘀 激光治疗：减少毛细血管渗漏，特别是阻止渗漏液进入黄斑部引起囊样水肿。 视网膜静脉周围炎（retinal periphlebitis） 多发生于20~40岁的男性人群，两眼多在一年内先后发病，又称Eales病，是视网膜血管炎的一种。特征为双眼反复发生的视网膜及玻璃体出血，病因不明。表现为视网膜周边部小静脉出血，血管旁有白鞘，病情反复发展。病程较长者，静脉炎引起广泛的血管闭塞，致视网膜大面积缺血，新生血管形成，引起更多的出血，继而诱发严