| Objective : To observe the angiographic features of patients with central retinal vein occlusion(CRVO) by using ultra wide-field fluorescein angiography(UWFFA) and compare peripheral retinal nonperfusion status of CRVO with which is in the traditional understandings. To explore the correlations between the areas of peripheral retinal nonerfusion and best correct visual acuity(BCVA),central mecular thickness(CMT) and iris neovascularization. And also to evaluate the guiding role of fully panretinal photocoagulation(PRP) in treating macular edema of CRVO.Methods :1 45 patients(45 eyes) of CRVO were enrolled to the study. And BCVA, intraocular pressure(IOP) were recorded. Slit lamp microscope, fundus photography, UWFFA, optical coherence tomography(OCT) are used in each patient to acknowledge eye status. To observe and summarize angiographic features of UWFFA and analyse the correlations between the areas of peripheral retinal nonerfusion and BCVA,central mecular thickness(CMT)and iris neovascularization.2 Of the 45 patients above, 32 patients(32 eyes) with CRVO macular edema are recuited in the groups of treatment study and classified into 3 groups : intravitreal injection group(24 eyes), operation group(6eyes) and retrobulbar rejection group(2eyes).While the 24 patients in intravitreal rejection group were randomly devided into two groups : group A(fully PRP) and group B( traditional PRP). Patients of intravitreal injection group received intravitreal injection of ranibizumab and triamcinolone acetonide(TA) combining with PRP and macular grid photocoagulation after injection. Group A received fully PRP while group B received traditional PRP. And after PRP, pro re nata(PRN) injection of ranibizumab were carried out according to the follow-up status. The Patients in operation group received Phaco+IOL,pars plana vitrectomy(PPV), internal limiting membrane(ILM) peeling, PRP and intravitreal injection of TA(4mg). The patients in retrobulbar rejection group were also injected TA(20mg). After these treatments, BCVA, CMT, UWFFA of each patient should be regularly carried out, and injection frequency within the 6 months after PRP of patients in intravitreal injection group were recorded.Results: Of the 45 patients enrolled, 43 patients(55.56%) showed confluent areas of nonperfusion in the retinal periphery with a mean area of 74.46±57.65 PD.While only 11 patients would be classified as nonperfused by the Central Retinal Vein Occlusion Study(CVOS) angiographic criteria. The mean areas of peripheral nonperfusion were not significantly different in the CVOS–perfused group(68.52±51.35PD) versus nonperfused group(95.24±75.31PD)(P > 0.05). Compared with patients without iris neovascularizatin(66.40±47.80PD), the mean areas of peripheral nonperfusion of the patients with iris neovascularizatin were significantly different. The area of peripheral nonperfusion was not correlated with CMT(r=0.147,P>0.05), but was correlated with BCVA(r = 0.297, P<0.05). During the 6 months follow-up,the injection frequency of group A is 0.78±0.80 while the injection frequency of group B is 2.70±0.95,and the difference is significant(P<0.05).Conclusions:1 Compared to traditional FFA, UWFFA has greater advatange of discovering the peripheral retinal abnormalities.2 The retinal nonperfusion of CRVO begins from the peripheral capillaries, and gradually expand to the posterior pole along with exacerbation of CRVO.3 The area of peripheral nonperfusion of CRVO is not correlated with CMT, but is correlated with BCVA, onset of disease and iris neovascularization.4 Compare the more comprehensive PRP guiding by UWFFA with traditional PRP, the former can better prolong the duration of curative effect of intravitreal injection and recurrence of macular edema. |
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