| Objective: To observe and analyze the incidence,clinical features,incidence-related factors of acute paramacular central-middle layer retinopathy(PAMM)in patients with retinal artery occlusion,and the efficacy of conservative treatment and ophthalmic artery thrombolytic therapy.Methods: Retrospective,clinical observational case study.Collected patients diagnosed with retinal artery occlusion in the Department of Ophthalmology of the First Affiliated Hospital of Dalian Medical university from January 2014 to August2020.Collect all patients’ general information,eye examination,blood lipids,homocysteine,past history of systemic diseases and treatment methods.Analyze the general clinical data,OCT characteristics,PAMM incidence,incidence-related factors,and the efficacy of conservative treatment and ophthalmic artery thrombolysis.Result:1.Clinical features of PAMM:There were 93 patients with retinal artery occlusion in this study.21 eyes were diagnosed as PAMM,and they were 34-77 years old,with an average of(59.00±12.48)years old;There were 13 male patients and 8 female patients.The central retinal artery was occluded in 15 eyes,and the branch retinal artery was occluded in 6 eyes.The best corrected visual acuity(log MAR)ranged from 0 to 1.0 in 6 eyes,1.1 to 3.0 in 13 eyes,and 4.0 to 5.0 in 1 eye;intraocular pressure fluctuated between 12 and 20 mm Hg,with an average of(15.76±2.52)mm Hg.8 patients had hypertension,3 patients had type 2 diabetes,3 patients had cerebrovascular disease,and 1 had coronary heart disease.Collect blood lipids and homocysteine of 16 patients,serum total cholesterol(4.99±1.11)mmol/L,triglycerides(1.36±1.01)mmol/L,high-density lipoprotein cholesterol(1.15±0.28)mmol/L,low-density lipoprotein cholesterol(2.88±0.85)mmol/L,homocysteine(16.35±13.93)umol/L.12 patients(57.1%)received Intra-arterial thrombolysis,and 9patients(42.9%)received standard treatment.2.Clinical characteristics: There was no statistically significant difference between the PAMM group and the non-PAMM group in gender,age,type of retinal artery occlusion and onset time(p>0.05).3.Relevant factors of PAMM: Among patients with retinal artery occlusion,the triglyceride level of PAMM group was lower than that of non-PAMM group,and the difference was statistically significant(p <0.05).The occurrence of PAMM had no statistically significant with serum total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and homocysteine levels(p>0.05).It was not related to hypertension,type 2 diabetes,coronary heart disease and cerebrovascular disease,and the difference was not statistically significant(P>0.05).4.The incidence of PAMM in patients with retinal artery occlusion was 22.58%(21/93).5.The SD-OCT characteristics of PAMM are as follows:(1)The reflection signal at the junction of the inner nuclear layer and inner plexiform layer and the junction of the inner nuclear layer and the outer plexiform layer is enhanced,and the SD-OCT appears as a "dual track sign" in 6 eyes(6/21);(2)Inner nuclear layer reflection signal is enhanced,and can be side-by-side enhanced signals or strips to enhance in 8 eyes(8/21);(3)Inner nuclear layer high reflection signals extend to the inner retina and involve ganglion cell layer in 6 eyes(6/21);(4)Inner nuclear layer strongly reflected signal extends to the outer retina,involving Helen fiber layer in 1 eye(1/21);(5)Chronic phase manifests as inner nuclear layer signal at the lesion decrease and thinning of the retina.6.Treatment: The vision of the PAMM group was improved after treatment,the difference was statistically significant(p≈0.000<0.05),the vision of the non-PAMM group was not improved after treatment,the difference was not statistically significant(p>0.05),PAMM After treatment,the visual acuity of the group was improved compared with the non-PAMM group,the difference was statistically significant(p≈0.000<0.05).After the PAMM group received standard treatment and intra-arterial thrombolysis,vision improvement after treatment was not related to the treatment method,and the difference was not statistically significant(p>0.05).Conclusion:1.The incidence of PAMM in patients with retinal artery occlusion was 22.58%(21/93).2.Among patients with retinal artery occlusion,there was no difference in gender,age,time of onset and type of retinal artery occlusion between PAMM group and non-PAMM group.3.The PAMM group had lower triglyceride levels.The occurrence of PAMM had nothing to do with serum total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and homocysteine levels,and was related to hypertension,type 2 diabetes,coronary heart disease,cerebrovascular disease.4.Patients with retinal artery occlusion and PAMM have a better prognosis.standard treatment and intra-arterial thrombolysis have no effect on the prognosis of PAMM. |
PDF Full Text Request