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钕钇铝石榴石激光腔内溶栓术:视网膜动脉阻塞的一种治疗方法。

Nd:Yag Laser Transluminal Embolysis: A Therapeutic Approach in Retinal Artery Occlusion.

作者信息

Tăbăcaru Bogdana, Abboud George, Munteanu Mihnea, Stanca Simona, Stanca Horia Tudor

机构信息

Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Clinical Department of Ophthalmology, "Prof. Dr. Agrippa Ionescu" Emergency Hospital, 011356 Bucharest, Romania.

出版信息

J Clin Med. 2024 Dec 22;13(24):7828. doi: 10.3390/jcm13247828.

Abstract

: Central and branch retinal artery occlusion (CRAO and BRAO) are critical causes of acute vision loss, predominantly affecting older adults with systemic vascular pathology. These occlusions typically result from embolic events, leading to partial or complete retinal ischemia. : This retrospective case series report details of our 10-year experience using the 1064 nm Nd:YAG laser for Transluminal Nd:YAG Embolysis (TYE) in order to lyse visible emboli within the retinal arteries. : We conducted a retrospective case series involving 18 patients treated by TYE for different retinal arteries occlusions between 2014 and 2024. TYE effectively restored blood flow in the occluded arteries, with variable but generally favorable visual outcomes. Our article highlights significant clinical and interventional aspects of three treated patients: a BRAO case with multiple transluminal emboli, a case of double BRAO and a CRAO case. We also report the successful use of TYE for intraluminal lysing of an embolus located outside the optic disc. The procedures were well-tolerated, with minor complications such as preretinal or vitreous hemorrhages resolving spontaneously. : TYE is a minimally invasive therapeutic option for retinal artery occlusion with visible emboli, particularly when intervention occurs shortly after the onset of symptoms. Compared to observation, TYE can improve visual outcomes and reduce the risk of permanent vision loss, presenting a significant advancement in the management of this ophthalmic emergency. The worldwide experience with TYE is continuously increasing. Further research with larger cohorts is recommended to validate these results and refine the treatment protocol.

摘要

视网膜中央动脉阻塞和分支动脉阻塞(CRAO和BRAO)是急性视力丧失的关键原因,主要影响患有全身性血管病变的老年人。这些阻塞通常由栓塞事件引起,导致部分或完全视网膜缺血。

本回顾性病例系列报告详细介绍了我们在10年中使用1064纳米Nd:YAG激光进行腔内Nd:YAG溶栓术(TYE)以溶解视网膜动脉内可见栓子的经验。

我们进行了一项回顾性病例系列研究,涉及2014年至2024年间接受TYE治疗不同视网膜动脉阻塞的18例患者。TYE有效地恢复了阻塞动脉的血流,视觉结果各异但总体良好。我们的文章重点介绍了三名接受治疗患者的重要临床和介入方面情况:一例有多发性腔内栓子的BRAO病例、一例双BRAO病例和一例CRAO病例。我们还报告了成功使用TYE对位于视盘外的栓子进行腔内溶解的情况。这些操作耐受性良好,视网膜前或玻璃体出血等轻微并发症可自发消退。

对于有可见栓子的视网膜动脉阻塞,TYE是一种微创治疗选择,尤其是在症状发作后不久进行干预时。与观察相比,TYE可以改善视觉结果并降低永久性视力丧失的风险,这代表了这种眼科急症治疗方面的重大进展。全球范围内对TYE的经验在不断增加。建议进行更大样本队列的进一步研究以验证这些结果并完善治疗方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a364/11677157/f8df7b4936ae/jcm-13-07828-g001.jpg

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