视网膜中央动脉阻塞的治疗研究现状及进展

摘要

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.%视网膜中央动脉阻塞(CRAO)最常见病因是栓子栓塞视网膜动脉.高血压是CRAO最常见的危险因素,而同侧颈动脉狭窄是CRAO发病中最有意义的危险因素.目前临床治疗手段包括扩张血管、降眼压等保守治疗以及溶栓、Nd∶ YAG激光等积极治疗.保守治疗同该疾病的自然病程相比较,并没有高质量的研究表明其预后更好.溶栓治疗虽能提高患者视力,但是因为其并存的风险以及无对照组研究而一直不能为临床提供有力的证据支持.发生CRAO后,患者还有可能再次发生其他部位的血管栓塞而引起不同程度的心脑血管事件.临床医师除了重视眼部治疗外,还应该将更多的焦点放在防止心脑血管事件的发生上,重视其全身危险因素的筛查并积极治疗,以降低心脑血管事件的发病率和死亡率.