摘要
目的 观察有无短暂性视网膜缺血发作(RTIA)史的非动脉炎性视网膜中央动脉阻塞(NA-CRAO)患者中心视力变化,探讨RTIA对患眼中心视力的保护作用.方法 2016年1月-2023年6月河南省人民医院诊治NA-CRAO患者175例(175眼),无RTIA史95例为无RTIA组,RTIA至NA-CRAO发病间隔时间≤2周38例为近期RTIA组,RTIA至NA-CRAO发病间隔时间＞2周42例为远期RTIA组.比较3组性别、年龄、合并症(高血压、糖尿病、高胆固醇血症、冠状动脉疾病)、吸烟史、饮酒史、脑梗死病史、发病至就诊时间、住院时间.3组入院时行光学相干断层扫描,测量患眼及健眼黄斑中心凹视网膜厚度(CRT).3组均采用保守治疗,分别于入院时及治疗1、3个月检测患眼最佳矫正视力(BCVA),并将BCVA换算为最小分辨角对数(logMAR)视力,比较中心视力好转率.结果 (1)3组年龄,发病至就诊时间,住院时间,男性、吸烟、饮酒、有脑梗死史及合并高血压、糖尿病、高胆固醇血症、冠状动脉疾病比率比较差异均无统计学意义(P＞0.05).(2)3组入院时患眼CRT比较差异有统计学意义(F=17.771,P＜0.001),健眼CRT比较差异无统计学意义(F=2.084,P=0.128).近期 RTIA 组入院时患眼 CRT[(308.39±34.46)μm]小于远期 RTIA 组[(341.00 ±44.38)μm]和无RTIA组[(360.74±50.40)μm](P＜0.05),远期RTIA组与无RTIA组比较差异无统计学意义(P＞0.05).(3)3组入院及治疗1、3个月时BCVA(logMAR)比较差异均有统计学意义(F=3.107,P=0.047;F=3.668,P=0.028;F=4.737,P=0.010),治疗1、3个月时BCVA(logMAR)与入院时比较差异均无统计学意义(P＞0.05).入院及治疗 1、3 个月时近期 RTIA 组 BCVA(logMAR)(2.10±0.88、2.00±0.88、1.90±0.86)均好于远期RTIA 组(2.46±0.81、2.37±0.80、2.31±0.78)和无 RTIA 组(2.47±0.77、2.40±0.76、2.35±0.75)(P＜0.05),远期RTIA组与无RTIA组比较差异无统计学意义(P＞0.05).(4)治疗1、3个月时近期RTIA组(18.4％、26.3％)、远期RTIA组(14.3％、23.8％)、无RTIA组(13.7％、20.0％)患眼中心视力好转率比较差异均无统计学意义(P＞0.05).结论 与NA-CRAO间隔时间短的RTIA对患眼中心视力有保护作用.
Abstract
Objective To observe the changes in central visual acuity in patients with non-arteritic central retinal artery occlusion(NA-CRAO)with or without a history of retinal transient ischemic attack(RTIA),and to explore the role of RTIA in protecting central visual acuity.Methods Totally 175 patients(175 eyes)with NA-CRAO in Henan Provincial People's Hospital from January 2016 to June 2023 were divided into 95 patients(95 eyes)without RTIA history(non-RTIA group),38 patients(38 eyes)with ≤2 weeks from RTIA onset to NA-CRAO onset(short-term RTIA group)and 42 patients(42 eyes)with＞2 weeks from RTIA onset to NA-CRAO onset(long-term RTIA group).The gender,age,comorbidities(hypertension,diabetes,hypercholesterolemia,coronary artery disease),smoking habits,alcohol consumption history,history of cerebral infarction,time from onset to visit,and length of hospital stay were compared among three groups.All patients underwent optical coherence tomography on admission to measure the central retinal thickness(CRT)of both affected and healthy eyes.All three groups received conservative treatment.The best-corrected visual acuity(BCVA)of the affected eyes was tested on admission and after 1-and 3-month treatment.The BCVA was converted to logMAR visual acuity,and the improvement rate of central visual acuity was compared.Results(1)There were no significant differences in the age,time from onset to visit,length of hospital stay,male ratio,and percentages of patients with smoking habits,alcohol consumption history,history of cerebral infarction,and comorbidities as hypertension,diabetes,hypercholesterolemia and coronary artery disease among three groups(P＞0.05).(2)There was a significant difference in the CRT of the affected eyes among three groups(F=17.771,P＜0.001),while there was no significant difference in the CRT of the healthy eyes(F=2.084,P=0.128).The CRT on admission was thinner in short-term RTIA group[(308.39±34.46)μm]than that in long-term RTIA group[(341.00±44.38)μm]and non-RTIA group[(360.74±50.40)μm](P＜0.05),and showed no significant difference between long-term RTIA group and non-RTIA group(P＞0.05).(3)There were significant differences in the BCVA(logMAR)on admission and after 1-and 3-month treatment among three groups(F=3.107,P=0.047;F=3.668,P=0.028;F=4.737,P=0.010),and the BCVA(logMAR)showed no significant difference after 1-and 3-month treatment compared with that on admission(P＞0.05).The BCVA(logMAR)values on admission and after 1-and 3-month treatment were lower in short-term RTIA group(2.10±0.88,2.00±0.88,1.90±0.86)than those in long-term RTIA group(2.46±0.81,2.37±0.80,2.31±0.78)and non-RTIA group(2.47±0.77,2.40±0.76,2.35±0.75)(P＜0.05),and showed no significant differences between long-term RTIA group and non-RTIA group(P＞0.05).(4)There were no significant differences in the improvement rates of central visual acuity of the affected eyes after 1-and 3-month treatment among short-term RTIA group(18.4％,26.3％),long-term RTIA group(14.3％,23.8％),and non-RTIA group(13.7％,20.0％)(P＞0.05).Conclusion RTIA in a short interval with NA-CRAO has a protective role in the central visual acuity of the affected eyes.
基金项目
河南省医学科技攻关省部共建重点项目(SBGJ202102034)
NETL
NSTL
万方数据