Messerli J
Universitätsaugenkliniken Bern/Basel.
Schweiz Med Wochenschr. 1993 Apr 24;123(16):783-8.
Particularly in patients over 40 years of age, disturbances of perfusion at the optic nerve head and retina are a frequent cause of acute visual acuity loss. As the most important disease entities, we must distinguish between ischemic optic neuropathy and arterial and venous perfusion disturbances. The prognosis with regard to visual acuity is, at any rate, serious: a considerable, persistent loss of vision must be expected. Unfortunately, at present there is no therapy available which could normalize perfusion quickly enough. In individual cases of ocular venous thrombosis, isovolumetric hemodilution can be effective. Use of argon-laser coagulation may markedly reduce the occurrence of severe complications (hemorrhagic glaucoma, vitreous bleeding). As an emergency measure, brief massage of the globe as well as administration of 100 mg prednisone and 250 mg acetazolamide are recommended. Disturbances in ocular perfusion call investigation with regard to hematological and vascular risk factors. It is always important to rule out giant-cell arteritis (Horton's disease).
特别是在40岁以上的患者中，视神经乳头和视网膜的灌注障碍是急性视力丧失的常见原因。作为最重要的疾病实体，我们必须区分缺血性视神经病变以及动静脉灌注障碍。无论如何，视力预后都很严峻：必然会出现相当程度的、持续性的视力丧失。不幸的是，目前尚无足够快速使灌注恢复正常的治疗方法。在个别眼部静脉血栓形成的病例中，等容血液稀释可能有效。使用氩激光凝固术可显著降低严重并发症（出血性青光眼、玻璃体出血）的发生率。作为应急措施，建议对眼球进行短暂按摩，并给予100毫克泼尼松和250毫克乙酰唑胺。眼部灌注障碍需要针对血液学和血管危险因素进行检查。排除巨细胞动脉炎（霍顿病）始终很重要。
