摘要目的 观察Nd:YAG激光击栓术联合尿激酶静脉溶栓治疗半侧及分支视网膜动脉阻塞(RAO)的治疗效果.方法 伴有黄白色栓子的半侧及分支RAO患者34例34只眼纳入本研究.患者临床表现典型,经眼底检查和荧光素眼底血管造影(FFA)检查确诊,病程12 h～9 d.采用美国科以人公司Lumenis调Q Nd:YAG激光器,在Ocular视网膜接触镜下行视网膜动脉栓子激光击栓术,治疗后次日给予尿激酶静脉溶栓治疗.治疗后复查视力、视野、眼底、FFA,根据造影早期荧光充盈显示阻塞的视网膜动脉主干及其分支血流恢复情况,将其分为完全恢复、基本恢复、部分恢复、无效.结果 34只眼经Nd:YAG激光击栓术后,FFA检查显示阻塞的视网膜动脉主干及其分支全部血流完全恢复者13只眼,占38.2%;基本恢复者11只眼,占32.4%;部分恢复者5只眼,占14.7%;无效者5只眼,占14.7%.联合尿激酶静脉溶栓治疗后,FFA复查显示阻塞的视网膜动脉主干及其分支全部血流完全恢复者16只眼,占47.1%;基本恢复者15只眼,占44.1%;部分恢复者3只眼,占8.8%.患者治疗前后视力比较,差异有统计学意义(x2=30.7,P＜0.05).视野检查眼前区域性暗影不同程度变淡,明显改善.治疗过程中未见全身并发症.结论 Nd:YAG激光击栓术联合尿激酶溶栓治疗对血栓引起的视网膜半侧及分支RVO安全有效.

abstractsObjective To evaluate the clinical effect of Nd:YAG laser embolysis combined urokinase thrombolysis therapy for branch retinal artery occlusion. Methods Thirty-four eyes of 34 patients with branch or hemi-retinal artery occlusion (RAO) were studied. All patients were confirmed according to the diagnosis criteria of RAO at acute stage, disease course ranged from 12 hours to nine days. Local retinal edema and the yellowish-white embolus within the retinal arteriole could be observed by color photograph and fundus fluorescein angiography (FFA) examination. Nd: YAG laser therapy was given to all eyes,which focused on the embolus by an ocular contact lens. The laser pulse was delivered directly and gradually by 0. 3-0. 9 mJ according to embolus condition. Fundus photographs and FFA were taken before and immediately after the laser treatment. On the next day after laser treatment, all patients received urokinase thrombolysis therapy through intravenous drip of 100 000-200 000 IU per time by two times for five consecutive days. Follow-up time ranged from two to three days after drug treatment and all patients