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 compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.MethodsFrom January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using t-test.ResultsAt 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients. ConclusionsUrokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.
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 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)
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.
ObjectiveTo observe the clinical characteristics of ophthalmic and cerebral artery occlusion after facial cosmetic injection.MethodsA retrospective case study. Twenty patients (20 eyes) with ophthalmic and cerebral artery occlusion in Department of Ophtalmology, The Fourth Hospital of Xi’an from February 2014 to December 2016 were enrolled in this study. There were 2 males (2 eyes) and 18 females (18 eyes). They aged from 21 to 41 years, with the mean age of 29.8±1.4 years. The disease courses was ranged from 3.5 hours to 21 days, with the mean of 40 hours. Facial cosmetic injections of all patients were performed at out-of-hospital beauty institutions. The visual impairment was associated with eyelid pain 1 to 10 minutes after injection.There were 12 right eyes and 8 left eyes.The injection materials, 18 patients were hyaluronic acid and 2 patients were autologous fat, respectively. At the injection site, 13 patients were sacral, 4 patients were nasal, and 3 patients were frontal. The concentration and dose of the injected filler were not known. All patients underwent vision, slit lamp microscope, fundus color photography, visual field, FFA, OCT, and brain CT, magnetic resonance angiography (MRA) examination.ResultsThe visual acuity was ranged from no light perception to 1.0. Among the 20 eyes, 3 eyes (15%) were obstructed by simple ophthalmic artery; 5 eyes (25%) were obstructed by ophthalmic artery combined with cerebral artery; 7 eyes (35%) were obstructed by simple retinal artery occlusion (RAO) alone, which including central RAO (CRAO, 4 eyes), hemi-lateral artery obstruction (1 eye) and branch RAO (2 eyes); 1 eye (5%) was CRAO with ciliary artery branch obstruction; 1 eye (5%) was branch artery occlusion with ischemic optic neuropathy; 2 eyes (10%) were CRAO with nasal dorsal artery occlusion; 1 eye (5%) was CRAO, posterior ciliary artery obstruction and right middle cerebral artery occlusion. Among 20 patients, 4 patients (20%) had eye movement disorder and eyelid skin bun; 2 patients (10%) had facial pain and nasal skin ischemic necrosis. MRA revealed 6 patients (30%) of new intracranial ischemic lesions. Among them, 5 patients of hyaluronic acid injection showed asymptomatic small blood vessel embolization; 1 patient of autologous fat injection showed ophthalmary artery occlusion, cerebral artery occlusion, ipsilateral eye blindness, eye movement disorder and contralateral limb hemiplegia.ConclusionFacial cosmetic injection can cause severe iatrogenic complications such as RAO, ciliary artery occlusion, ischemic optic neuropathy, ophthalmic artery occlusion, and cerebral artery occlusion.
ObjectiveTo observe the clinical features of retinal arterial occlusion (RAO) in youth.MethodsThis is a retrospective case review. Nine patients (9 eyes) with RAO were enrolled in this study. There were 6 males (6 eyes) and 3 females (3 eyes). The average age was (14.22±3.93) years. The best-corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus color photography and fundus fluorescein angiography were performed. All patients underwent systemic evaluation including blood routine, erythrocyte sedimentation rate, blood lipids, vasculitis screening, homocysteine level, antiphospholipid antibody, blood coagulation, neck vascular ultrasound, and cardiac color ultrasound and electrocardiogram examination. All patients received oxygen therapy, blood medications and symptomatic treatment. Meanwhile, the patients with autoimmune diseases were received systemic glucocorticoid therapy. The follow-up was ranged from 6 to 12 months. The visual acuity and fundus change before and after treatment were compared.Resultsamong 9 patients, one patient had systemic lupus erythematosus, one patient had congenital heart disease, one patient had hypergammaglobulinemia, and carotid artery color ultrasonography showed that the internal carotid artery vessels faltered in 2 cases. The BCVA was 0.01 - 0.12. Among 9 eyes, there were 5 eyes (55.6%) with retinal branch artery occlusion (BRAO), 2 eyes (22.2%) with central retinal artery occlusion (CRAO), 2 eyes (22.2%) with ciliary retinal artery occlusion (CLAO). CRAO eyes showed positive RAPD (relative afferent pupillary defect), fine retinal artery and the corresponding vein, pale white retinal edema in posterior area and macular cherry-red spot. BRAO eyes manifested as inferior temporal artery occlusion and pale white retinal edema around them. CLAO eyes showed temporal ligulate grey-white retinal edema. At the last follow-up, BCVA improved and retinal vessels returned to normal in 7 eyes (77.8%); BCVA unchanged and no improvement in fundus in 2 eyes (22.2%).ConclusionAdolescent RAO is mostly partial occlusion, the prognosis is generally good after early active treatment.
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)
Embolus occlusion in the retinal artery is the most common cause of central retinal artery occlusion (CRAO), while hypertension is the most common risk factor of CRAO, and ipsilateral carotid artery stenosis is the most significant risk factor in CRAO. Current clinical treatments include conservative treatments such as dilation of blood vessels and lowering the intraocular pressure (IOP), as well as aggressive treatments like intravenous thrombolysis and Nd:YAG laser. Both thrombolysis and Nd:YAG laser treatment can improve the visual acuity of CRAO patients, but because of its lack of randomized controlled trials, further clinical studies are needed to determine their efficacy and safety. CRAO patients may have vascular embolism at other sites in the body, and may cause different degrees of cardiovascular and cerebrovascular events. The probability of secondary ocular neovascularization following the occurrence of these events is 2.5% to 31.6%. In addition to eye care, clinicians should also focus more on preventing cardiovascular and cerebrovascular events, and focus on the screening and active treatment of systemic risk factors to reduce the incidence and mortality of cardiovascular and cerebrovascular events.
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.