Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Emergency Medicine, Turkey.
Kahramanmaraş Sütçü İmam University Faculty of Medicine, Department of Ophthalmology, Turkey.
Toxicon. 2021 Jul 30;198:54-63. doi: 10.1016/j.toxicon.2021.04.008. Epub 2021 May 4.
In this study, the early retinal and optic nerve blood flows of patients exposed to Viper bite were evaluated with non-invasive optical coherence tomography angiography (OCTA) and compared with healthy controls. The retinal and optic disc OCTA data of 31 victims of viper bite (group S) without systemic envenomation clinical symptoms and 31 healthy controls (group C) were compared. Only patients with early signs of envenomation were included in the study. Optical coherence tomography angiographies were performed with RTVue XR Avanti with AngioVue software. Vascular densities in the whole image, foveal, parafoveal regions at the superficial and the deep capillary plexus segments were acquired and statistically analyzed. The flow area parameters were measured in the superficial retinal capillary plexus, deep retinal capillary plexus, outer retinal capillary plexus, and choriocapillaris layers of the macula in 1-mm and 3-mm diameter areas. The peripapillary flow areas were measured for the optic nerve head, vitreous, radial peripapillary capillary (RPC), and choroid in a 4.50-mm diameter area. Foveal and parafoveal thicknesses were also measured and compared. The average hospital admission time of the patients in group S was 1.24 ± 0.75 (0.50-3.00) hours. Age (p = 0.103) and gender (p = 0.714) were similar in both groups. Superficial (p = 0.010), deep flow areas (p = 0.034), and superficial parafoveal vascular density (p = 0.001) were significantly reduced in group S compared to group C. The outer retinal flow area (p < 0.001) increased significantly in group S. Nerve head flow area (p = 0.035), one of the optic disc flow areas, was found to be decreased in group S. Notably, foveal (p < 0.001) and parafoveal (p = 0.003) thicknesses and superficial (p = 0.001) and deep (p < 0.001) foveal vascular densities were greater in group S. Compared to group C, the superficial (p = 0.009) and deep (p = 0.009) foveal flow areas in the central foveal area with a diameter of 1 mm increased significantly in group S. Viper venom may cause blood flow changes in the retina and optic disc and an increase in retinal thickness in the early period although there are no signs of systemic envenomation.
在这项研究中，我们使用非侵入性光学相干断层扫描血管造影术（OCTA）评估了暴露于蝰蛇咬伤的患者的早期视网膜和视神经血流，并与健康对照组进行了比较。比较了 31 名无全身性蛇毒中毒临床症状的蝰蛇咬伤患者（S 组）和 31 名健康对照者（C 组）的视网膜和视盘 OCTA 数据。仅纳入有早期蛇毒中毒迹象的患者进行研究。使用 RTVue XR Avanti 与 AngioVue 软件进行 OCTA。获取并统计分析全像、中心凹和旁中心凹浅层和深层毛细血管丛段的血管密度。在 1mm 和 3mm 直径区域测量浅层视网膜毛细血管丛、深层视网膜毛细血管丛、外层视网膜毛细血管丛和黄斑区脉络膜毛细血管层的血流面积参数。在直径 4.50mm 的区域测量视乳头周围血流面积，包括视乳头、玻璃体、放射状视乳头毛细血管（RPC）和脉络膜。还测量并比较了中心凹和旁中心凹的厚度。S 组患者的平均住院时间为 1.24±0.75（0.50-3.00）小时。两组间年龄（p=0.103）和性别（p=0.714）无差异。与 C 组相比，S 组浅层（p=0.010）、深层血流面积（p=0.034）和浅层旁中心凹血管密度（p=0.001）显著降低。S 组外层视网膜血流面积（p<0.001）显著增加。S 组视神经头血流面积（p=0.035），即视盘血流面积之一，减少。值得注意的是，S 组中心凹（p<0.001）和旁中心凹（p=0.003）厚度以及浅层（p=0.001）和深层（p<0.001）中心凹血管密度增加。与 C 组相比，S 组 1mm 直径中心凹区的浅层（p=0.009）和深层（p=0.009）中心凹血流面积显著增加。尽管没有全身性蛇毒中毒的迹象，但蝰蛇毒液可能会导致视网膜和视盘血流变化以及早期视网膜厚度增加。
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