背景:年轻患者的视网膜动脉闭塞事件很少见。然而,因为怀孕期间的生理多因素适应,视网膜血管闭塞性疾病可自发发生。此外,卵圆孔未闭是缺血性血栓栓塞事件的危险因素.自从荧光素血管造影,评估这些闭塞的核心工具,在怀孕期间应该避免,光学相干断层扫描血管造影,一种新颖的技术,为可视化视网膜组织的血管灌注提供了很好的机会。
方法:在这里,我们介绍了一个由三名患者组成的病例系列(高加索人,非吸烟者)由于急性视力障碍和中央暗点瘤而来我们诊所就诊。使用常规光学相干断层扫描和光学相干断层扫描血管造影,检测到视网膜血管阻塞,从而启动对系统性风险因素的评估。我们报告了两名患者(30岁和32岁),他们发展了毛细血管视网膜动脉阻塞,但其病因不同:一个是与卵圆孔未闭相关的血栓栓塞起源,而另一种是由视网膜中央静脉阻塞继发的血液动力学阻滞引起的。在这两种情况下,光学相干断层扫描血管造影显示毛细血管视网膜动脉阻塞再灌注。然而,短暂性缺血在几周后导致视网膜萎缩。第三个病人(32岁),暗点发作后8周,光学相干断层扫描血管造影显示中层萎缩和深毛细血管丛灌注受损,因此诊断为急性中央中度黄斑病变。所有患者恢复了正常的视力,并且没有复杂的妊娠,实验室血液检查没有发现任何缺陷或改变。
结论:如下所示,光学相干断层扫描血管造影可以在妊娠期对视网膜血管灌注进行无风险成像.与常规光学相干断层扫描一起,它允许人们根据现有的视网膜阻塞相关的萎缩来预测功能结果。
BACKGROUND: Retinal arterial occlusive events in young patients are rare. However, because of physiological multifactorial adaptations during pregnancy, retinal vascular occlusive disease may occur spontaneously. In addition, a patent foramen ovale is a risk factor for an ischemic thromboembolic event. Since fluorescein angiography, a central tool in the evaluation of these occlusions, should be avoided during pregnancy, optical coherence tomography angiography, a novel technique, offers a good opportunity for visualizing vascular perfusion of retinal tissue.
METHODS: Here we present a case series of three patients (Caucasian, nonsmoker) who visited our clinic owing to acute visual impairment and central scotoma. Using regular optical coherence tomography and optical coherence tomography angiography, retinal vascular occlusions were detected, thus initiating the evaluation of systemic risk factors. We report two patients (30 and 32 years old) who developed cilioretinal artery occlusion but whose etiology differed: one was of thromboembolic origin associated with patent foramen ovale, while the other was caused by hemodynamic blockade secondary to central retinal vein occlusion. In both cases, optical coherence tomography angiography revealed reperfusion of the cilioretinal artery occlusion. However, transient ischemia led to retinal atrophy after a few weeks. In the third patient (32 years old), 8 weeks after onset of scotoma, optical coherence tomography angiography revealed atrophy of the middle layers and impaired perfusion in the deep capillary plexus, and thus a paracentral acute middle maculopathy was diagnosed. All patients regained normal visual acuity and had otherwise uncomplicated pregnancies, and laboratory blood tests did not reveal any defects or alterations.
CONCLUSIONS: As shown here, optical coherence tomography angiography enables risk-free imaging of retinal vessel perfusion during pregnancy. Together with regular optical coherence tomography, it allows one to predict functional outcome according to the existing retinal occlusion-related atrophy.