Vitrectomy for macular edema combined with retinal vein occlusion

This study was performed in order to evaluate the effect of vitrectomy in eyes with retinal vein occlusion associated with macular edema. Twenty-nine years eyes (27 patients) with branch retinal vein occlusion (BRVO), and 14 eyes (13 patients) with central retinal vein occlusion (CRVO) both associated with macular edema underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy and peeling of the posterior hyaloid membrane. Follow-up ranged from 12 to 32 months. Macular edema was reduced, and visual improvement was observed (p < 0.0001 in BRVO, p = 0.0257 in CRVO, paired t-test). Visual outcome was better in eyes with better visual acuity before surgery. Early vitrectomy may be recommended for retinal vein occlusion associated with macular edema. This revised version was published online in July 2006 with corrections to the Cover Date.     

Vitrectomy for chronic macular edema associated with branch retinal vein occlusion

PURPOSE: To study the outcome after vitrectomy for chronic and acute macular edema associated with branch retinal vein occlusion (BRVO). MATERIALS AND METHODS: Medical charts of fifty-five patients (55 eyes) who underwent vitrectomy for macular edema associated with BRVO were reviewed retrospectively. Patients were followed up for more than one year after the vitrectomy. We compared the visual and structural outcome between an early group (i. e., edema lasting less than one year) and a late group (i.e., edema lasting more than one year). RESULTS: The mean visual acuity improved significantly from 0.088 to 0.163 in the early group and from 0.147 to 0.132 in the late group. Seventy percent of the cases improved in angiographic findings and eighty percent of the cases improved in optical coherence tomography findings. CONCLUSIONS: Vitrectomy for chronic macular edema even lasting more than one year after BRVO seems to be effective, depending on the case.     

Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion

PURPOSE: To assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO). METHODS: This prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT). RESULTS: There were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1-3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.     

玻璃体腔注射曲氨奈德与Bevacizumab治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿疗效比较

目的 比较玻璃体腔注射曲氨奈德(triamcinoloneacetonide,TA)与抗血管内皮生长因子单克隆抗体(Bevacizumab)治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿(NI-CME)的临床疗效.方法 采用单中心非随机对照临床回顾性研究,共47例经眼科常规检查以及荧光素眼底血管造影(FFA)和光学相干断层扫描(OCT)检查确诊的NI-CME患者的47只眼纳入观察.患者被分成两组进行玻璃体腔注射TA(4mg/0.1m1)或Bevacizumab(1.25rag/0.05m1)治疗.TA组28例,注射次数1～2次,随诊时间(5.98 4±4.35)月.Bevacizumab组19例,注射次数1-3次,随诊时间(3.20±2.92)月.两组在术前年龄、病程、最佳矫正视力(BCVA)、中心视网膜厚度(CMT)方面均无统计学意义.比较治疗前和治疗后4、8、12周两组间以及各组内部的BCVA、CMT的改变.结果 两组间视力在4周(t=0.141,P=0.889)、8周(1=-1.637,p=0.127)、12周(t=-0.479,P=0.650)时均无统计学意义;CMT在4周(t=0.479,P=0.650)、8周(t=0.743,P=0.478)、12周(t=-1.979,P=0.083)时均无统计学意义.治疗后眼压明显升高仅见于TA组.结论 玻璃体腔注射TA或Bevacizumab治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿,短期内均能明显改善视力,减轻黄斑水肿.此结果还需大样本、多中心的临床随机对照研究.     

玻璃体腔注射曲氨奈德与Bevacizumab治疗非缺血性视网膜中央静脉阻塞继发黄斑水肿疗效比较

Objective To compare the effect of intravitreal triamcinolone vs intravitreal bevacizumab for the treatment of macular edema in non-ischaemic central retinal vein occlusion.Methods The comparative single-center nonrandomized retrospective clinical interventionalstudy included 47 eyes of 47 patients with non-ischaemic CRVO, macular edema was diagnosed by examination of regular inspection, fundus fluorescein angiography(FFA) and optic coherence tomography(OCT ).This cases were divided into a a triamcinolone group of 28 patients (4.0 mg triamcinolone) and bevacizumab group of 19 patients (1.25 mg bevacizumab). During follow-up, 1.1±0.8 re-injections of the triamcinolone group (range: 1-2 injections) and 1.5± 1 re-injections ofbevacizumab (range: 1-3 injections) were administered.The mean follow-up were 5.98±4.35 months in TA group and 3.20±2.92 in bevacizumab group.At baseline, both study groups did not vary significantly in age, duration of symptoms ,visual acuity (BCVA),center macular thickness (CMT).Comprehensive ophthalmic evaluation was performed at baseline and at weeks 4,8,12 after treatment.Main outcome measures included CMT measured with OCT and BCVA. Results No significant differences between groups were observed for BCVA at week4(t=-0.141, P=0.889), 8(t=-1.637, P=0.127), 12(t=-0.479, P=0.650 )and for CMT at weeks4 (f=-0.479, P=0.650), 8 ((=0.743, P=0.478), 12 (t=1.979, P=0.083).There was a significant increase in 10P in the TA group. Conclusion The result in our observation showed that intravitreal injection of either triamcinolone acetonide or bevacizumab was well tolerated with a significant improvement in BCVA and decrease in macular edema for patients with non-ischaemic retinal vein occlusion .A randomly controlled multicenter clinical trial is necessary.     

Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion

BACKGROUND: To evaluate the efficacy of intravitreal triamcinolone acetonide injection on persistent macular oedema in branch retinal vein occlusion that fails to respond to previous laser photocoagulation. MATERIAL AND METHODS: A total of 19 eyes of 19 patients with persistent macular oedema due to branch retinal vein occlusion were treated with 8 mg/0.2 ml of intravitreal triamcinolone acetonide injection. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular oedema map values of Heidelberg Retinal Tomograph II (HRT II) before and after intravitreal triamcinolone injection. RESULTS: The mean follow-up time was 6.2+/-1.0 months. The mean baseline best-corrected logarithm of minimal angle of resolution (LogMAR) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.01+/-0.16. After treatment, it was 0.55+/-0.22 at the 1-month, 0.56+/-0.22 at 3-month, and 0.62+/-0.22 at the last visits and the differences were statistically significant when compared with baseline values (for each, P<0.001). The mean oedema map values on HRT II significantly decreased by 28.5% at 1-month, 23.8% at 3-month, and 23.8% at the last visit when compared with preinjection values (for each, P<0.001). Intraocular pressure elevation exceeding 21 mmHg was observed in 26.3% of eyes at 1-month, 15.7% at 3-month, and 5.2% at the last visit, but was controlled with topical anti-glaucomatous medications in all eyes. CONCLUSION: Intravitreal triamcinolone acetonide application is a promising approach in the treatment of persistent macular oedema due to branch retinal vein occlusion non-respondent to laser photocoagulation.     

玻璃体切割术治疗视网膜静脉阻塞性玻璃体出血

目的 评价玻璃体切割术后治疗视网膜静脉阻塞性玻璃体出血的疗效。方法 回顾性分析我院自1996年6月－1999年6月经玻璃体切割术治疗的视网膜静脉阻塞性玻璃体出血31例31眼的临床资料。结果 随访9－45个月。随访时31眼视网膜均在位,视力提高者27眼（占87．1％）,其中≥0．1者22眼,最好视力为0．8,有4眼视力无改变。术后玻璃体再出血2例,经药物治疗后出血吸收。无新生血管性青光眼发生。结论 玻璃体切割术是治疗视网膜静脉阻塞性玻璃体出血的有效方法,可明显改善患者视力;结合激光光凝治疗,可有效预防玻璃体再出血及新生血管性青光眼等并发症的发生。     

Vitrectomy prevents retinal hypoxia in branch retinal vein occlusion

Vitrectomy has been shown to halt diabetic retinal neovascularization, but the mechanism of this process is unknown. We propose that vitrectomy improves the oxygen supply to ischemic inner retina by way of fluid currents in the vitreous cavity. In order to test this hypothesis, we induced branch retinal vein occlusion in cats and measured preretinal oxygen tension before and after branch retinal vein occlusion in ten nonvitrectomized and five vitrectomized eyes. Branch retinal vein occlusion caused a significant decrease in preretinal oxygen tension in nonvitrectomized eyes, in which the oxygen tension fell from 20 +/- 7 to 6 +/- 5 mmHg (P = 0.001). Conversely, in vitrectomized eyes the oxygen tension was not significantly reduced after branch retinal vein occlusion. The data demonstrate that branch retinal vein occlusion causes retinal hypoxia in nonvitrectomized eyes, whereas after vitrectomy the hypoxic effect of branch retinal vein occlusion is reduced. The relief of retinal hypoxia that follows vitrectomy may be responsible for halting retinal neovascularization after vitrectomy in diabetic patients.     

玻璃体手术治疗继发于视网膜分支静脉阻塞的视网膜脱离

目的 探讨继发于视网膜分支静脉阻塞（BRVO）的视网膜脱离（RD）的临床特点和玻璃体手术的治疗效果。方法 回顾分析45例（45眼）继发于BRVO的RD的临床特点、治疗方法和预后。结果 45眼RD患者术前和术中检查发现，合并视网膜裂孔25眼，完全玻璃体后脱离（PVD）16眼。44眼均完成玻璃体手术，术后随访6—84个月。视力提高28眼（63．64％），稳定11眼（25．00％），下降5眼（11．36％）。手术后视力与手术前视力比较，差别有显著统计学意义（χ^2=4．04，P〈0．01）；完全PVD组与无或仅部分PVD组的手术后视力比较，差别有显著统计学意义（χ^2=2．97，P〈0．01）。第1次手术后视网膜成功复位39／45眼（88．64％），最终视网膜成功复位44／45眼（97．78％）。结论 继发于BRVO的RD有其独特的临床表现。玻璃体手术能有效地治疗继发于BRVO的RD，术后绝大多数患者视力改善，视网膜成功复位。     

Surgical macular decompression for macular edema in retinal vein occlusion

BACKGROUND: Recently, a number of surgical and laser approaches have been used to improve visual outcome in cases of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Intravitreal steroid injection alone appears to offer only temporary improvement at best. Radial optic neurotomy for CRVO and arteriovenous adventitial sheathotomy for BRVO are the most frequently utilized surgical procedures for these conditions, but evidence regarding efficacy is still lacking. We have suggested that macular decompression by internal limiting membrane (ILM) peeling may reduce macular edema and hemorrhage and improve visual acuity by relieving elevated intraretinal tissue pressure and facilitating egress of blood and extracellular fluid out of inner retinal layers into the vitrectomized vitreous cavity. METHODS: 50 cases of severe visual loss due to macular edema caused by CRVO or BRVO, not eligible for laser photocoagulation, underwent pars plana vitrectomy with removal of preretinal hyaloid, peeling of the ILM stained with indocyanine green dye, air-fluid exchange, and postoperative prone positioning. RESULTS: In all cases, intraretinal blood and retinal thickening diminished within 6 weeks of surgery. Visual acuity improved in 87% of CRVO cases and 68% of BRVO cases. Vision improved and stabilized at 39 days after surgery. Average improvement was 2.6 lines with a 6-line improvement in 1 case. There was no difference in outcome between cases with ischemic or nonischemic features on fluorescein angiography. INTERPRETATION: Macular decompression using vitrectomy and ILM peeling is effective in the treatment of severe visual loss due to macular edema in CRVO and in those BRVO cases that do not qualify for laser photocoagulation.