I think everyone is familiar with the word "stroke", but what most people don't know is that in the ophthalmology community, there is another disease that is also scary, which is " eye stroke" - —Central retinal artery occlusion (hereinafter referred to as CRAO). What kind of disease is this that gives ophthalmologists such a headache?
Central retinal artery occlusion is one of the top ten emergencies in ophthalmology. The onset is sudden, and vision can be completely lost immediately or within a few minutes. Even with treatment, most patients' vision does not return to normal levels. Therefore, how to improve the prognostic vision of patients with dynamic obstruction has always been a difficulty that ophthalmologists want to overcome.
Ms. Sun, who is in her thirties, is a senior white-collar worker in a company. She is usually in good health and rarely gets sick. After finishing work that day, I wanted to pick up my phone and watch a TV series, but suddenly I found that I couldn't see the screen clearly with my right eye. At first, she thought her eyes were too tired from working on the computer and wanted to take a break and observe again. One day later, she found that the situation was getting worse. When she closed her left eye, she couldn't even see the faces of the colleagues next to her. Ms. Sun panicked and rushed to Henan Provincial Eye Hospital ( Henan Provincial People's Hospital Ophthalmology Department ) found Professor Song Zongming for outpatient treatment.
Professor Song Zongming examined Ms. Sun and found that the visual acuity of her right eye was only 0.01, which could not be improved even after wearing glasses. When further dilating the pupil fundus examination, it was found that the macular area retina is ischemic, showing a cherry-like red color. Fluorescein angiography of the eye confirmed that Ms. Sun suffered from central retinal artery occlusion in her right eye, which is the "ocular stroke" we mentioned earlier.
Normal fundus photo
After hearing the diagnosis, Ms. Sun could not sit still anymore and asked quickly: "Doctor, I know this is a stroke in the brain. What is a stroke in the eyes? I am not going to go blind, am I?" Professor Song Zongming replied: Don't worry, the retina has a central vein and an artery respectively. When the central artery is embolized, the eye suddenly loses oxygen and nutrient supply, which can cause sudden vision loss. This is usually not accompanied by obvious pain. This condition is called central retinal artery occlusion. On the retina of the normal fundus, there is a circular area with a diameter of about 550 microns, which is yellow-brown due to its rich lutein content. It looks like a "yellow patch" under an ophthalmological microscope, which is called macula (see picture above). The macula is located at the back of the eye and is responsible for receiving images directly in front of the eye. The macular area contains a high density of photoreceptor cells - cones, which are the sharpest areas of vision and help us see all bright things clearly and recognize the three-dimensional sense of things. When there is a problem with the macula, the vision of the eye will be significantly reduced, and things will feel like they are being blocked.
"Then what should I do now?" Ms. Sun asked.
"The main purpose of CRAO treatment is to embolize and restore blood supply to blood vessels as soon as possible. Current injection treatment methods include fine needle eye puncture and drainage or using drugs to reduce intraocular pressure, massaging the eyeball to promote embolus movement, and inhaling oxygen to reduce retinal defects. He checked the oxygen status, contacted the internal medicine department for thrombolytic treatment, etc., but most of them could not improve the vision." Seeing that Ms. Sun was a little frustrated, Professor Song told her, "Since the cause of CRAO is similar to the pathogenesis of cerebral infarction, myocardial infarction and other diseases, lysis should be used. Suppository drugs can effectively restore perfusion in retinal ischemic areas and improve visual function, and the effect is better than traditional treatment methods. Currently, we have a new method using intraocular injection of recombinant tissue plasminogen activator (tPA). and intravenous medication to achieve therapeutic effects by dissolving embolism. There are currently few reports on this treatment method in China, but through our observations, the treatment effect for most patients is far better than traditional treatment methods. "
So, after obtaining Ms. Sun's advice. After agreeing, the doctor admitted her to the hospital and quickly administered intraocular drug injections and intravenous drugs. On the first day after treatment, the visual acuity of her right eye improved from 0.01 to 0.03, and the fundus ischemia gradually improved.On the 18th day after treatment, the visual acuity stabilized at 0.03. When retinal angiography was performed again, the blocked blood vessels had been unclogged and vascular perfusion had also improved significantly.
Fundus photos (left picture: before treatment, right picture: 18 days after treatment, the macular area of the retina changes from white to rosy)
Eye OCT (left picture: before treatment, right picture: 18 days after treatment, the retina is visible) The edema has improved significantly)
According to Professor Song Zongming, Henan Provincial Eye Hospital (Ophthalmology Department of Henan Provincial People's Hospital) was the first to adopt this new treatment method in China. It has treated many patients so far, but most of them have been ill for several days. For patients who have missed the best treatment time, the new treatment method is still better than the traditional treatment method. Most of the patients have improved vision, and in some early cases, the vision has even returned to normal vision.
Professor Song emphasized that, like brain "stroke", eye "stroke" also has an optimal treatment period. The treatment effect is best within 1-2 hours of the onset. The patient's vision is more likely to improve within 12 hours, and the effect will be better after 30 hours. Poor, so if you find eye discomfort, you must seek medical advice as soon as possible.
The current risks of new treatment methods are mainly cataracts, retinal holes/detachments, and systemic bleeding, including intracranial/throat/gastrointestinal tract/genitourinary/pulmonary/five senses/solid organ bleeding, etc., so there is a tendency for bleeding or hemorrhage Patients with diseases require more detailed evaluation during treatment. Our hospital team has communicated and collaborated with relevant departments such as the Department of Cardiology and Neurology, and will provide timely consultation and take corresponding treatment measures if it occurs. As a provincial doctor, we uphold the hospital spirit of “benevolence, erudition, rigor, and excellence” and strive to provide advanced medical technology and excellent medical services to protect the health of the people.
Contributed by: Zhang Panpan Huang Zixu
