Central retinal vein occlusion (CRVO) is a common retinal vascular disease with blinding complications. It is divided into central retinal vein occlusion and branch vein occlusion, and is divided into ischemic and non-ischemic according to the size of the capillary non-perfusion zone in fluorescein fundus angiography.
The main manifestations are visual impairment, often sudden, visual acuity may be reduced to manual or exponential, central visual field central dark spot and paracentral dark spot. Fundus examination has optic papillary edema with blurred borders, dilated and distorted blood vessels, retinal hemorrhages of varying sizes, flame-like in the superficial layers and lamellar in the deeper layers, and in severe cases, preretinal hemorrhage and vitreous hemorrhage. Macular cystoid edema, retinal exudate spots.
Major comorbidities
(1) Macular edema, which is the main cause of prognostic visual acuity
(2) neovascularization and neovascular glaucoma, about 30% incidence, neovascular glaucoma usually 3-4 months after the onset, difficult to control with drugs, become refractory glaucoma, the prognosis is very poor.
The main causes are hypertension, atherosclerosis, hyperlipidemia, increased blood viscosity, vascular inflammation and other conditions such as oral contraceptives, increased intraocular pressure, emotional stress, and overexertion.
In Chinese medicine, it belongs to the category of “complex damage and violent blindness” and is clinically classified as
(1) Qi stagnation and blood stasis due to internal injury of emotion and liver qi stagnation.
(2) Yin deficiency and Yang hyperactivity due to Yin deficiency of liver and kidney.
(3) phlegm and blood stasis due to excessive fatty food and phlegm-dampness.
(4) Heart and spleen deficiency due to overexertion, dark depletion of yin and blood, and deficiency of heart and blood.
The main tests are fluorescence angiography and OCT to determine the degree of central and branch vein obstruction, ischemic and non-ischemic and macular edema.
Treatment: Western medical treatment is relatively single. Based on our previous treatment experience, we combine Western medicine and traditional Chinese medicine with high treatment rate and good prognosis. Briefly described as follows.
First, intravenous injection of vasodilator drugs and nutritional drugs, which can dilate retinal blood vessels, improve blood circulation, help absorption of hemorrhage, reduce neovascularization, subside macular edema and restore vision.
Second, oral administration of Chinese herbal medicine, according to the identification of Chinese medicine, targeted with the rationalization of qi to relieve depression, remove blood stasis and stop bleeding, nourish yin and submerge yang, remove blood stasis and open the ligaments, benefit qi and blood intake, etc.
Third, according to Chinese medicine meridian theory, acupuncture point main shot therapy, to dredge the meridians, blood activation and brightening effect. At the same time, auricular acupuncture point paste is added to assist the treatment.
Fourth, local ultrasonic therapy to promote local blood circulation in the eye, increase local resistance, help blood absorption and reduce edema.
Fifth, post-injection of vasodilator and a small amount of hormone drugs, local concentration increased, anti-inflammatory, swelling, and reduce neovascularization formation.
Sixth, the capillary non-perfused area of the fundus is larger than six optic disc areas, and laser treatment is actively performed to prevent neovascularization.
Through the above treatment, the patient’s visual acuity was restored, the hemorrhage was absorbed, the edema subsided, and basically no cases of neovascularization were seen. The prognosis is good.