Ang central retinal artery occlusion ay dulot ng vascular spasm, thrombus formation, at external compression na nagdudulot ng obstruction sa blood supply sa inner layer ng retina, na nagdudulot ng acute ischemia at malaking pagbaba ng vision. Ito ay isa sa mga emergency cases sa opthalmology na nagdudulot ng blindness. Ang aming department ay nakatanggap ng 21 mga kaso ng central retinal artery occlusion mula Marso 1995 hanggang Marso 2001, at lahat ay ginamit ang integrative Western and Traditional Chinese Medicine therapy, na nagresulta sa satisfying outcome. Narito ang report:
1. Klinikal na Datos
Ang 21 mga kaso ay binubuo ng 18 lalaki at 3 babae; ang youngest ay 28 taon, ang oldest ay 66 taon, average age 54 taon; 14 mga kaso sa kanan, 7 sa kaliwa; trabaho: 3 mga driver, 10 mga government officials, 8 retirees; shortest duration was only 20 min, longest was 24 hours. Physical examination: ang vision ay lahat ay less than finger count in front of eyes. Ang pupils ay nangyari sa different degrees, direct light reflex weakened or absent, indirect light reflex present. Ang fundus vessels ay line-shaped or completely absent, the posterior pole of retina ay grayish-white, cloudy edema, cherry-red spot at macula.
2. Paraan ng Paggamot
Agad na after diagnosis, immediate sublingual nitroglycerin 10mg, retrobulbar injection of Tolazoline 1205mg, or injection of compound camphor alkaloid into the temporal artery and supraorbital artery each 2ml, local eye massage, oral acetazolamide 500mg, and oxygen therapy. At the same time, add intravenous infusion of compound Danshen 16ml once daily, 10 sessions per course; also oral compound Danshen tablets, Vimanlutong, and other blood-activating and stasis-resolving herbs.
3. Epekto ng Paggamot
3.1 Epekto Standard
Excellent: vision ≥1.0; Effective: vision improved ≥3 lines; Improvement: vision improved 1–2 lines; Ineffective: no change in vision.
3.2 Resulta
After one course of treatment, follow-up for 3 months: among 21 cases, 5 excellent, 11 effective, 4 improvement, 1 ineffective, total effective rate 95.2%. The order of vessel recovery: first nasal superior, temporal superior, then nasal inferior, temporal inferior.
4. Diskusyon
Ang central retinal artery and its branches are terminal arteries supplying blood to the inner layer of the retina. The retina is extremely sensitive to circulatory disturbances. In animal (rabbit) experiments, when the central artery is completely blocked, the retina dies within 30 minutes. Another report says the tolerance time for transient retinal ischemia is about 100 minutes. Therefore, this is an ophthalmologic emergency requiring urgent rescue to restore circulation before retinal necrosis occurs, to achieve good outcomes. Among the 5 excellent cases, the reasons for successful rescue include: younger patient, the occlusion might be due to fatigue and transient hypertension causing vascular spasm, timely use of vasodilators and drugs to relieve microvascular spasm, gradually restoring circulation; second, the patient came early enough and we actively secured treatment time; third, we added blood-activating and stasis-resolving herbs early in treatment. Research confirms that these herbs have four major effects in treating ocular ischemic diseases: ① dilate blood vessels, reduce vascular resistance. ② improve microcirculation, enhance hypoxia tolerance. ③ inhibit fibrin synthesis, anticoagulant and anti-proliferation. ④ inhibit release of allergic mediators, anti-allergic reaction. Because of these effects, the blocked artery reopened faster. Some unsatisfactory results may be due to older age, higher degree of vascular sclerosis, and late presentation.
There are many reports on central retinal artery occlusion clinically, but detailed observations are rare. Through observation, we found that the order of retinal vessel recovery is nasal superior, temporal superior, nasal inferior, temporal inferior—gradually returning from distal to proximal. Although the superior and inferior branches receive normal blood supply, there is still mild edema in the macular region, possibly because the blood supply to the outer edge of the macula comes from the nasal and temporal retinal artery branches, which form radial vascular loops that have not fully recovered yet.
Literature reports on 21 cases of central retinal artery occlusion, 2 occurred in the morning. In our group, 5 cases also occurred around 6 a.m., possibly because upon waking from sleep, blood flow is slow, and upon activity, blood flow increases rapidly, leading to a sharp rise in chemicals like adrenaline, increasing blood flow, vasoconstriction, blood pressure, and blood viscosity, approaching peak levels during the day, making vascular spasm more likely, especially in those with hypertension or arteriosclerosis. Therefore, it is advisable to move limbs gently before getting out of bed to gradually increase blood flow from slow to fast, preventing vascular disorders.
Central retinal artery occlusion is not just a local retinal condition but also a symptom of systemic disease. Therefore, while treating this condition, it is essential to actively treat the underlying systemic diseases causing it.
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