| 目的 视网膜静脉阻塞（RVO）是仅次于糖尿病性视网膜病变的常见致盲性眼病，居于第二位。由于病程长且对各种治疗反应差，现已成为眼科的主要慢性、难治性眼病。药物治疗疗程长、疗效差。激光光凝对静脉阻塞本身起不到治疗和缓解的作用。激光诱导脉络膜视网膜静脉吻合术实际上是视网膜和脉络膜间的“激光搭桥术”，是利用脉络膜循环来改善视网膜循环障碍的旁路通道技术。目前存在吻合成功率低的问题，国内尚处于动物实验性阶段。本实验旨在探讨在通过氩激光建立兔眼视网膜分支静脉阻塞（branch retinal vein occlusion，BRVO）模型基础上，用氩激光随后用Nd：YAG激光诱发建立视网膜和脉络膜吻合术来提高吻合的成功率。
方法 通过建立来自白求恩医科大学动物实验室的灰色家兔22只（44只眼）BRVO模型。实验组10只（20只眼）在氩激光基础上加用Nd：YAG激光诱发形成视网膜和脉络膜静脉间的吻合；对照组10只（20只眼）单独用氩激光诱发形成视网膜和脉络膜静脉间的吻合。组织学制作2只（4只眼）；1只（2只眼）在光镜下观察，1只（2只眼）在电镜下观察。
结果 在激光击射的当时用Goldman三面镜下可见在视盘缘附近耳侧约1/4DD的静脉局部血管变细，远端静脉扩张。通过FFA检查及组织切片均证实成功建立BRVO的模型。在之后的观察中实验组20只眼中6只形成视网膜脉络膜吻合，形成时间为4-6周。对照组没有形成吻合。检眼镜下激光击射部位静脉中断呈漏斗状陷入脉络膜。FFA显示远端及近端静脉内血流汇入吻合处，在近端静脉内可见血流从视盘逆向流入吻合处。在观察2-6个月期间由激光击射引起的脉络膜视网膜或玻璃体出血均在8周内吸收，未见其它严重并发症。
结论 由于视网膜静脉与脉络膜静脉间在生理状态存在压力梯度，而且在RVO的情况下这种压力梯度将会增加，因此视网膜与脉络膜之间的吻合支可行。本实验用氩激光随后用Nd：YAG激光诱导视网膜脉络膜静脉吻合比单独用氩激光诱导视网膜脉络膜静脉吻合成功率高。取得各激光的治疗参数，以提高视网膜静脉的治愈率。这项技术有很好的发展前景。
关键词：视网膜静脉阻塞
Abstract
Objective: This experimental research aimed to improve the efficacy
of the argon laser followed by the Nd: YAG laser-induced chorioreti-
nal venous anastomosis in the rabbit’ eyes with a model of branch
vein occlusion.
Methods: Immediately after branch retinal vein occlusion(BRVO) model was made by argon laser in 44 eyes of 22 normal rabbits. The rabbits were divided into two groups: In the first group there were 10 rabb-
Its in treated with the argon laser followed by the Nd: YAG laser-in-
duced chorioretinal venous anastomosis. In the second group, the rab-
bits were treated only with the argon laser-induced chorioretinal ve-
nous anastomosis.
Results: An anastomosis of the first group was formed in 6 rabbits
With in 4-6 weeks after treatment while no anastomosis in the other
group was formed. During the 2 to 6 months’ follow-up the hemorrhage in choroids, retina and vitrous associated with laser photocoagula-
tion was absorbed within 8 weeks and no other severe complications
were found .
Conclusion: On the base of the branch retinal vein occlusion(BRVO)
model, applying the argon laser followed by the Nd: YAG laser-induced can improve the efficacy of anastomosis in the rabbits’ eyes. We
are sure of a brilliant future of this technique.
Key words: retinal vein occlusion anastomosis. |
