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目的:研究探讨视盘内注射组织凝血酶原激活剂治疗视网膜中央静脉阻塞的可行性及有效性。方法:利用光敏剂及氩激光制备兔眼视网膜静脉组塞模型,经FA确认后随机分组。治疗组(10眼,20支静脉)视盘内注射12.5μg tPA/0.05mL。对照组(12眼,24支静脉)视盘内注射0.05mL BSS。分别在注入后的第3,7d行FAG检查确认视网膜静脉的再通情况,同时行裂隙灯及间接眼底镜检查,并行病理组织学检查。结果:利用光敏剂及氩激光成功地复制出了兔眼视网膜静脉组塞模型并经视网膜静脉荧光造影确认。治疗组阻塞静脉的再通率是70.0%(14/20),对照组阻塞静脉的再通率是16.7%(4/24)(P=0.001)。结论:视盘内注射12.5μg tPA/0.05mL提高了阻塞静脉的再通率,经睫状体扁平部向视神经内注射tPA有望成为局部用药治疗CRVO的新方法。视神经内注射tPA的安全性量及最佳量-效关系有待进一步研究。
Objective: To investigate the feasibility and effectiveness of intra-ocular injection of tissue prothrombin activator in the treatment of central retinal vein occlusion. Methods: Rabbit retinal vein occlusion model was prepared by photosensitizer and argon laser. After confirmation by FA, they were randomly divided into groups. The treatment group (10 eyes, 20 veins) received intraperitoneal injections of 12.5 μg tPA / 0.05 mL. The control group (12 eyes, 24 veins) received 0.05 mL BSS. On the 3rd and 7th day after injection, FAG was used to confirm the recanalization of retinal vein, and slit lamp and indirect ophthalmoscopy were performed simultaneously, and histopathological examination was performed. Results: Rabbit retinal vein occlusion model was successfully replicated by photosensitizer and argon laser and confirmed by retinal vein fluorescein angiography. In the treatment group, the recanalization rate of occluded veins was 70.0% (14/20) and in the control group, the recanalization rate of obstructive veins was 16.7% (4/24) (P = 0.001). CONCLUSION: Intravenous injection of 12.5 μg tPA / 0.05 mL increases the recanalization rate of occluded veins and injection of tPA into the optic nerve via the ciliary body flats is expected to be a novel approach for the topical treatment of CRVO. The amount of intraocular injection of tPA safety and the best volume-effect relationship needs further study.