看图片病例学视网膜分支静脉阻塞

看图片病例学视网膜分支静脉阻塞 看图片病例学视网膜分支静脉阻塞(BRVO)【资深眼科医生整理共享】 2014-10-16 中国眼科医生 概述 视网膜分支静脉阻塞(Branch retinal vein occlusion)临床上较中央静脉阻塞为多见。发病因素与视网膜中央静脉阻塞相似。其中视网膜动静脉的解剖关系尤为突出。视网膜分支静脉阻塞多发生在颞侧(90.3%),尤其是颞上象限(54.9%).而且在阻塞处均发现有静脉后位交叉压迫征(100%),故静脉后位交叉可能是视网膜分支静脉阻塞的危险因素之一。 临床表现 【症状】 视力正常或不同程度减退。视网膜分支静脉阻塞对视功能的影响,因阻塞支的大小与所在部位而异。鼻侧支阻塞一般不影响视力,而黄斑一小分支阻塞,也严重影响视力。如果发生黄斑水肿或玻璃体积血视力将会明显下降。 【眼底表现】 常于动静脉交叉处发生阻塞。眼底病变(静脉扩张、充血、纡曲,视网膜出血、水肿、渗出等)只限于阻塞静脉引流区域,呈三角形分布,三角形的尖端指向阻塞所在处(一般指向视盘).阻塞可发生在不同的分支,使视网膜受累范围不等。愈近视神经的大分支,视网膜病变愈广,但影响到黄斑引流的分支,即使很小分支,视力亦严重受害.随着病程进展,出血、水肿吸收,视网膜静脉不再纡曲扩张,可有白鞘形成。还可见不规则的扭曲的视网膜新生血管,有的已形成侧支循环。 彩图一:颞上分支阻塞，阻塞点以后静脉扩张，分布区域内散在片状出血及棉绒斑，黄斑区局部水肿。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 彩图二:上半侧阻塞，尤其颞上方明显，浓厚火焰状出血，遮盖视网膜血管 ， 黄斑区广泛水肿。 彩图三:颞上分支阻塞，出血较浓厚，黄斑区水肿伴硬性渗出。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 彩图四:颞下分支阻塞，视盘边界欠清，浓厚出血，黄斑水肿伴硬渗。 彩图五:颞下分支阻塞，深浅层出血均有，不太浓厚，阻塞的静脉扩张，病变区 呈三角形分布，尖端指向视盘。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 彩图六:黄斑小分支阻塞，火焰状出血伴棉绒斑，虽然范围不大但黄斑水肿明显。 彩图七:病变中晚期，出血大部分吸收，残留小片出血，静脉扩张不明显，仍有 软、硬性渗出，病变区及黄斑水肿存在。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 彩图八:病变晚期，出血已吸收，动静脉比例正常，病变区及黄斑无明显水肿，阻塞血管呈白鞘(或白线)状，有侧枝循环形成。 【眼底荧光血管造影】 1.在视网膜分支静脉阻塞的早期,由于视网膜出血掩盖,不能观察阻塞区内的循环障碍及结构变化,但可见该处视网膜水肿及未被遮盖的纡曲扩张的静脉。静脉充盈时间延长。阻塞远端静脉渗漏荧光素,管壁及周围组织着染荧光素。阻塞严重者渗漏显著并在造影早期即可出现。分支静脉阻塞视网膜受累区域往往在水平分界的上或下半侧,眼底荧光血管造影十分醒目。受累的一侧因组织着染呈现一界线分明的强荧光区。 2.在视网膜分支静脉阻塞的晚期,由于深层毛细血管受损,可呈现毛细血管闭塞的无荧光区。有时毛细血管前小动脉也表现闭塞。在毛细血管闭塞区内,还可见微血管瘤、新生血管与侧支循环形成。 FFA图一:颞上方血管被浓厚出血遮盖，不能观察阻塞区内的循环障碍及结构变化。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities FFA图二:病变区出血少，可见阻塞血管充盈时间延长，其分布区域内有大片 无灌注区。 FFA图三:在造影晚期可以看到病变血管因内皮受损，有管壁着染。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities FFA图四:有些病例虽然无灌注区很广泛，但形成很多侧枝循环，可没有新生 血管出现。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities FFA图五:很多病例如果未经过光凝或随诊，会出现严重的新生血管。 相关疾病: 视网膜分支静脉阻塞 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 【并发症】 黄斑水肿及新生血管是视网膜分支静脉阻塞两个主要并发症.新生血管在主干分支静脉阻塞的发生约为28.8,30.94%.眼底新生血管最早于阻塞后1-3月出现。可发生在视网膜与视盘上。分支阻塞新生血管在视网膜上为20.6%,视盘上为3.7%.常发生在阻塞区视网膜无灌注区的边缘上。视网膜新生血管多从阻塞支小静脉或毛细血管长出,也有从非阻塞支小静脉萌芽者;开始呈芽胞状,以后成丝网状,花圈状或海扇状。新生血管可破裂,导致玻璃体反复出血,其发生率为14.2-20%。伴有部分玻璃体后脱离者,由于对视网膜与视盘上新生血管的牵拉而易致出血。 三、治疗与预后 视网膜分支静脉阻塞的视力预后较视网膜中央静脉阻塞好。最后视力为0.5以上者,在分支静脉阻塞为53%,60%. (一) 全身病的诊治 由于本病的发病大多与全身情况有关,因此,为预防阻塞进一步发展或另眼发病,需作仔细的全身检查及适当处理;全身治疗高血压、动脉硬化、高血脂、糖尿病、血液情况和感染病灶等。由于50%,70%的患者有高血压、心血管疾病或糖尿病。经过综合治疗对防止并发症与对侧眼的发病有助。 (二) 药物: 1.纤溶与抗凝 早期谨慎地用纤溶制剂减少血凝,促使纤维蛋白溶解,有一定疗效。理论上抗凝剂有助于预防血栓形成,临床上并无肯定疗效,还可能引起脑出血等重要并发症,现已很少采用。 2.降低血液粘稠度 较多患者血液粘稠度增高,低分子右旋糖酐有减少血液粘稠度、改进微循环的作用。阿斯匹林可抑制血小板聚集,现多用小剂量,25mg,50mg,每日一次,可长期服用。潘生丁可抑制血小板的释放反应、减少血小板凝集,25mg/每日3次。 3.抗炎治疗 青年患者多为血管炎症所致,全身如有阳性发现,可作针对性抗炎治疗,如抗结核、风湿、链球菌感染等。在抗炎的同时可适当加用激素。 4.中医中药 结合全身辩证施治,以活血化瘀为主的治疗。 (三) 激光治疗,分支静脉阻塞合并持续的黄斑水肿或/和荧光血管造影证实毛细血管无灌注超过7PD时,可予激光治疗。当无灌注区小于7PD时，应密切随访，对于不能按时随访者，可提前光凝。光凝时需时刻记住两个光凝斑之间的距离,尽量避免光斑融合及重叠,并注意勿过量光凝。光凝后需定期随诊。如有需要,4,6周后复查眼底及荧光血管造影。如仍有渗漏或新生血管不退,再补充治疗。以后3,6月复查,注意新生血管有无复发或在其他非无灌注区长出新生血管。 (四)手术 出现严重的玻璃体积血可行玻切手术治疗。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 光凝图片一:模式图 光凝图片二:经过及时正确的光凝后，出血及水肿逐渐吸收。 光凝图片三:光凝量要足够，如果光斑稀少，无法达到治疗作用，仍然会有新生 血管形成或未消退。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 光凝图片四:光斑稀少的原因:可能操作者技术或经验不足，抑或有出血及水肿 遮挡，总之，在光凝4-6周后要复查FFA，必要时要补充光凝。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 来源:丁香园 fml_0_0 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities