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高压氧治疗视网膜中央动脉阻塞:患者选择与展望。

Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives.

作者信息

Celebi Ali Riza Cenk

机构信息

Atakent Education and Research Hospital, Department of Ophthalmology, Acibadem University School of Medicine, Istanbul, Turkey.

出版信息

Clin Ophthalmol. 2021 Aug 13;15:3443-3457. doi: 10.2147/OPTH.S224192. eCollection 2021.

Abstract

The central retinal artery occlusion (CRAO) is a rare ophthalmological emergency that can occur in the eye. CRAO can affect persons of any age, however it is most common in people over the age of 60. CRAO is associated with a number of risk factors, including giant cell arteritis, carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and thromboembolic disease. The chance of each of these etiologies being present is assessed during the course of the investigation. Hyperbaric oxygen treatment (HBOT) is classified by the American Heart Association for CRAO at level IIb. In accordance with that, HBOT might be considered for the treatment of such a severe condition. HBOT can maintain retinal oxygenation during ischemic events by allowing oxygen to diffuse through choroidal capillaries that have been exposed to elevated partial pressures of oxygen. As a result, ischemia-related damage is reversed if applied within proper time frame. The amount of time that has passed prior to initiation of HBOT is considered to be the most critical factor in determining the best visual prognosis. According to the Undersea and Hyperbaric Medical Society, patients who are identified with CRAO after the onset of symptoms should be evaluated for HBOT within 24 hours. HBOT has the advantage of having a low risk profile, and it can be utilized to improve visual outcomes in proper patients.

摘要

视网膜中央动脉阻塞(CRAO)是一种可发生于眼部的罕见眼科急症。CRAO可影响任何年龄段的人群,但在60岁以上人群中最为常见。CRAO与多种危险因素相关,包括巨细胞动脉炎、颈动脉粥样硬化、心源性栓子、高血压、吸烟、糖尿病和血栓栓塞性疾病。在调查过程中会评估这些病因各自存在的可能性。美国心脏协会将高压氧治疗(HBOT)对CRAO的分类为IIb级。据此,对于这种严重病症的治疗可考虑采用HBOT。HBOT可通过使氧气扩散穿过已暴露于高氧分压下的脉络膜毛细血管,在缺血事件期间维持视网膜氧合。因此,如果在适当的时间范围内应用,与缺血相关的损伤可得到逆转。开始HBOT之前所经过的时间被认为是决定最佳视力预后的最关键因素。根据水下和高压氧医学协会的说法,在症状出现后被诊断为CRAO的患者应在24小时内接受HBOT评估。HBOT具有风险低的优势,可用于改善合适患者的视力结果。

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