視網膜中央靜脈阻塞

Central Retinal Vein Occlusion

 

視網膜中央靜脈阻塞

 

視網膜中央靜脈阻塞 (Central Retinal Vein Occlusion, CRVO) 是一種較常見的視網膜血管疾患。臨床上,CRVO主要症狀為視力喪失,眼底常出現視網膜出血、擴張及迂曲的視網膜靜脈、棉絮斑、黃斑水腫及視盤水腫。
一般認為CRVO主要影響50歲以上患者。臨床一般可分為兩個類型 ― 缺血性和非缺血性。

非缺血性CRVO影響較輕,有輕微視力減退、較少有視網膜出血和棉絮狀斑,而且有良好視網膜血液灌注。非缺血性CRVO有機會完全康復,但亦可發展成缺血性類型。
缺血性CRVO對視覺有嚴重影響,發病初期可呈現為缺血性類型,也可從非缺血性進展而成。缺血性CRVO患者臨床表現有嚴重視力喪失、廣泛的視網膜出血和棉絮狀斑及視網膜灌注差。患者最終有可能發展新生血管性青光眼而致失明。

有澳洲研究指年齡愈大發病機會愈大,年齡在49-60歲發病率為0.7%,80歲以上的患者為4.6%。(Mitchell P, Smith W, Chang A. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol. Oct 1996;114(10):1243-7.).

只有約10%非缺血性CRVO的病例可以完全恢復而沒有任何併發症。而50%的患者視力可能只有20/200 (0.1)或更差。約三分之一的患者會於發病後第6-12個月進展為缺血性類型。

超過90%的缺血性CRVO患者,最後視力可能僅有20/200 (0.1)或更差。60%患者可於發病後數週至2年內發展成新生血管性青光眼。另有報導指約有一成患者,對側眼睛可能會發展為視網膜靜脈阻塞。

此病對應中醫眼科中"視瞻昏渺"及"暴盲"疾患。早期中醫治療,可增加機會改善視網膜血液循環以減輕視網膜水腫、出血及缺氧等狀況,以減輕發生嚴重後遺症之可能。中醫治療以服用中藥及配合針灸治療為主。

 

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