视网膜静脉阻塞相关因素的临床观察

目的：分析视网膜静脉阻塞(retinal vein occlusion,RVO)的相关因素及临床治疗效果。

方法：对122例124眼RVO患者的临床资料进行回顾性分析。其中缺血型患者中分支静脉阻塞12眼(9.7%)、中央静脉阻塞6眼(4.8%),非缺血型分支静脉阻塞59眼(47.6%),中央静脉阻塞47眼(37.9%)。平均年龄60.6±11.8岁。高血压病史48例(39.3%),糖尿病10例(8.2%); 伴有一种以上相关疾病20例(16.4%); 无相关病史的有37例(30.3%)。仅采用药物保守治疗68例,联合激光治疗49例,行玻璃体切割术1例。

结果：愈后显效72眼(58.1%); 有效22眼(17.7%); 无效的15眼(12.1%); 愈后退步15眼(12.1%)。

结论：CRVO是全身与局部致病因素共同作用的结果。临床治疗需辩证对待,对眼底出血的时间、受累部位及范围结合眼底血管造影进行全面评估,进行个性化治疗,从而全面提高患者疗效。     

视网膜静脉阻塞动物模型的制作方法

视网膜静脉阻塞(RVO)分为视网膜分支静脉阻塞和视网膜中央静脉阻塞,是以视网膜静脉扩张迂曲、血流瘀滞、出血和水肿为特征的病变,常并发黄斑水肿和新生血管,新生血管型青光眼是其最严重的并发症。视网膜静脉阻塞对视力危害较大,是仅次于糖尿病性视网膜病变的第二大致盲性眼病。目前为止,视网膜静脉阻塞的患病人数增多,但其发病机制尚未完全明了,而且也无长久有效的治疗方法。实验室中动物模型对视网膜静脉阻塞发病机制和治疗方法的研究至关重要,因此本文对视网膜静脉阻塞实验中使用的动物及模型的制作方法做了简要综述,并对各种视网膜静脉阻塞动物模型的优缺点进行讨论。     

Methods for making animal models of retinal vein occlusion

Retinal vein occlusion (RVO) is divided into branch retinal vein occlusion and central retinal vein occlusion. It is characterized by retinal vein dilatation and tortuosity, blood flow stasis, bleeding and edema. It is often accompanied by macular edema (ME) and neovascularization. Neovascular glaucoma is the most serious complications. RVO is the second most common cause of visual loss classified under retinal vascular disorders after diabetic retinopathy. So far, the number of patients suffering from retinal vein occlusion has increased, but the pathogenesis of retinal vein occlusion has not been fully understood and there are no treatments that are very long-lasting. The research of animal models on the pathogenesis and treatment of the RVO is very important. Therefore, this article gives a briefly review to the animals and model making methods used in retinal vein occlusion experiments, and discusses the advantages and disadvantages of various RVO animal models.     

Aqueous levels of erythropoietin in acute retinal vein occlusion with macular edema

AIM: To investigate the aqueous erythropoietin (EPO) levels and associated factors in patients with acute retinal vein occlusion (RVO).METHODS:The aqueous EPO level was measured in patients with macular edema (ME) secondary to acute branched retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Aqueous fluid from cataract patients served as the control. We also evaluated whether aqueous level of EPO was associated with factors such as serum EPO level, non-perfusion area, central macular thickness (CMT), and arterio-venous (AV) transit timeRESULTS:Twenty-seven RVO patients (16 BRVO, 11 CRVO) and 9 control subjects were enrolled in the study. The aqueous EPO level (mU/mL) was higher in RVO (68.2±54.3) than that in the control subjects (12.9±5.9). More specifically, the aqueous EPO level was higher in CRVO (118.9±52.1) than that in BRVO (33.3±10.8). However, no differences were found in serum EPO levels among three groups. CMT in RVO patients had a positive correlation with the aqueous EPO level (r=0.66). Also, in terms of non-perfusion area, the aqueous EPO levels were more elevated in the ischemic subgroup than in the non-ischemic subgroup in both BRVO and CRVO.CONCLUSION:Aqueous EPO levels are elevated in patients with macular edema secondary to recent onset RVO. Patients with CRVO have higher EPO levels than those with BRVO. The aqueous EPO level in RVO has a positive correlation with CMT and is associated with non-perfusion area. These results suggest that the aqueous EPO level could be associated with retinal ischemia and may be involved in the pathogenesis of macular edema secondary to RVO.     

Ocular neovascularization with retinal vascular occlusion-III. Incidence of ocular neovascularization with retinal vein occlusion

A prospective natural history study was conducted in 721 eyes with various types of retinal vein occlusion (RVO) to determine the incidence of various types of ocular neovascularization (NV) and the factors that influence the development of ocular NV. The material was 360 eyes with central retinal vein occlusion (CRVO), 97 eyes with hemi-CRVO, and 264 eyes with branch retinal vein occlusion (BRVO); these cases were further subdivided into six groups for logical data analysis: nonischemic CRVO (venous stasis retinopathy-VSR, 282 eyes), ischemic CRVO (hemorrhagic retinopathy-HR, 78 eyes), hemi-VSR (66 eyes), hemi-HR (31 eyes), major BRVO (191 eyes) and macular BRVO (73 eyes). Ocular NV attributable to RVO was seen only in HR, hemi-HR, and major BRVO. In HR the anterior segment was the major site of NV, with iris and angle NV and neovascular glaucoma (NVG), while in hemi-HR and major BRVO the retina and optic disc were the major sites of NV. The principal factor influencing the development of ocular NV in RVO seems to be the severity and extent of retinal ischemia, while duration of follow-up since onset also plays an important role in determining the incidence of ocular NV. The findings and subject of ocular NV in RVO are discussed in detail along with a review of the pertinent literature.     

Demographic characteristics,patterns and risk factors for retinal vein occlusion in Nepal: a hospital‐based case–control study

Purpose: Retinal vein occlusion (RVO) is an increasing problem leading to visual impairment in Nepal. Our study investigates the demographic characteristics, patterns and risk factors for RVO in this developing Asian country. Methods: This is a hospital‐based case–control study conducted at the Tilganga Institute of Ophthalmology of Nepal during the period of January 2007 to January 2008. All consecutive new cases of RVO diagnosed at the Institute were included. Cases with intraocular inflammation or a prior history of intraocular injections, laser therapy or vitrectomy for RVO were excluded from the study. Age, sex and geographically matched subjects were recruited as a control group from patients who presented for regular eye examinations at the same hospital during the study period. Results: A total of 218 patients with RVO presented during the study period. The mean age of the patients was 61.1 ± 12.3 years with more men (58.3%) than women. The mean age for control groups was 61.3 ± 13.0 years. Seventy per cent of subjects had branch retinal vein occlusion, whereas central retinal vein occlusion was present in 26.6%. 63.9% of branch retinal vein occlusion was found in the superotemporal branch. Hypermetropia, primary open angle glaucoma, hypertension, mixed diabetes and hypertension, and heart disease were significantly higher in RVO cases as compared with the control group. Conclusion: The demographic characteristics, patterns and risk factors of RVO in Nepal can help guide interventions against these blinding diseases in similar developing countries.     

Multifocal electroretinogram in retinal vein occlusion

Purpose

To determine the effects of retinal vein occlusion (RVO) on multifocal electroretinogram (MF-ERG) parameters, to correlate MF-ERG and standard electroretinogram (ERG) and to correlate MF-ERG with findings of optical coherence tomography (OCT) in cases of RVO.

Methods

Both eyes of 50 patients with RVO and 50 eyes of 25 normal subjects were examined using MF-ERG, standard ERG, fluorescein angiography and OCT. The latency in millisecond (ms) and response density in nanovolt (nv/degenerations) were measured for each of four quadrant areas and central area. OCT was used to measure the foveal retinal thickness. Fluorescein angiography was used to measure retinal ischemia.

Results

Central retinal vein occlusion (CRVO) markedly affected all parameters of MF-ERG. In pathological quadrants in branch retinal vein occlusion, the response densities of MF-ERG were decreased and latencies of p-wave were prolonged. The MF-ERG responses obtained from eyes with RVO were significantly different (P > 0.05) from derived from the fellow eyes. The amplitude of MF-ERG were abnormal in 40 eyes and implicit times were delayed in 48 eyes compared with normal subjects. While 30 Hz flicker implicit were abnormal in only 24 eyes with RVO. Implicit times were prolonged in eyes with macular ischemia than in eyes without ischemia.There were significant correlation between foveal retinal thickness measured by OCT and P response density MF-ERG in cases of retinal vein occlusion.

Conclusion

MF-ERG is more susceptible than standard ERG to eye changes of RVO due to the multiple frequencies of stimulation used to record MF-ERG response. MF-ERG could be sensitive indicator of underlying disease affecting the retinal in eyes with RVO. MF-ERG is useful for detecting local retinal dysfunction in patients with RVO and sensitive to morphological changes and functional disorders induced by RVO.     

激光治疗视网膜静脉阻塞疗效分析

目的 评价激光在治疗视网膜静脉阻塞中的作用和疗效。方法 使用美国HGM M－5氩氪激光机、日本Nidek GYC-2000倍频532激光机及法国光太（BIV）VIRIDIS－LIET 532激光机对112例视网膜中央或分支静脉阻塞的患者进行光凝治疗。随访6－18个月，对比分析光凝前后视力、眼底及眼底荧光血管造影（FFA）结果的变化情况。结果 36眼缺血型视网膜中央静脉阻塞中22眼有效，占61．11％；6眼好转，占16．67％；8眼因玻璃体出血、继发青光眼或并发白内障失明而无效，占22．22％；76眼视网膜分支静脉阻塞中59眼有效，占77．63％；13眼好转，占17．11％；4眼无效，占5．26％，总有效率达72．32％。视力提高的84眼，占75％。结论 激光光凝术对治疗视网膜静脉阻塞有显著疗效。     

Natural course of experimental retinal vein occlusion in rabbit; arterial occlusion following venous photothrombosis

BACKGROUND: Retinal vein occlusion (RVO) is the second leading cause of vascular eye disease. Currently there is no definite treatment for this condition. Animal models could be potentially helpful in developing new treatments; however, it is essential to understand the differences these models may have with human RVO. The aim of our study was to examine the course of experimentally created retinal vein occlusion (RVO) in rabbits. METHODS: Twenty-nine pigmented rabbits were included in the study. RVO was created in all using an argon green laser following intravenous injection of Rose Bengal. A laser was applied to all major veins at the optic disc margin to mimic central retinal vein occlusion. Animals were followed-up for a maximum of 2 months. RESULTS: Immediately following laser application, blood flow ceased or the flow was extremely slow in the retinal veins in all cases. At day 2 post laser, 86% showed significant retinal hemorrhages. On FA, no retinal blood flow was observed in the eye (neither arteries nor veins) in the majority of rabbits. Between weeks 1 and 3, laser sites reopened and partial or complete revascularization of both retinal arteries and veins occurred; however, the vascular pattern was abnormal. CONCLUSIONS: RVO in rabbits has a different course than in human and it can be classified into three stages. At stage 1 (the first few days after laser photothrombosis), there is a retrograde propagation of the blood clot in the retinal veins that extends to the retinal arteries and choriocapillaries. As a result, there is no retinal blood flow at this stage in most cases. At stage 2 (between weeks 1 and 3), partial or complete revascularization occurs but the vessels have an abnormal pattern. At stage 3 (after week 3) no significant change takes place.     

视网膜静脉阻塞引起黄斑水肿的药物治疗进展

视网膜静脉阻塞(retinal vein occlusion,RVO)是临床上常见的眼底血管病,其高发性和对视力的危害性仅次于糖尿病性视网膜病变。RVO的特点是视网膜静脉扩张迂曲,沿静脉分布区域的视网膜出血、水肿和渗出,累及黄斑区时引起黄斑水肿(macular oedema,MO),久之将导致严重的中心视力损害。RVO疾病已被命名有100多年,但是一直以来RVO引起的MO的治疗比较困难。随着治疗方法的不断推新,特别是长效皮质类固醇及近年来的抗血管内皮生长因子类药物的应用,使该病的治疗效果有了较大的改观。我们从RVO引起MO的机制、糖皮质激素和抗血管内皮生长因子药物的作用机制及治疗进展等方面进行阐述,并提出了RVO的未来治疗展望。     

玻璃体腔内注射康柏西普联合532激光治疗视网膜静脉阻塞

目的：评价0.5mg的康柏西普注射联合532激光对视网膜静脉阻塞(RVO)的效果及安全性。

方法：2015-05/2016-03住院治疗的RVO病例122例122眼,按照随机数字表法随机分为研究组58例58眼(其中中央静脉阻塞患者24例24眼,分支静脉阻塞患者34例34眼)和对照组64例64眼(其中中央静脉阻塞患者26例26眼,分支静脉阻塞患者38例38眼)。两组患者行康柏西普玻璃体腔内注射术。研究组注射药物前行532激光治疗。治疗前及治疗后1、3、6mo复查行光学相干断层扫描(optical coherence tomography,OCT)检查,比较两组最佳矫正视力(best corrected visual acuity,BCVA),黄斑中心凹厚度及视网膜色素上皮(RPE)隆起的面积。

结果：治疗后1、3、6mo两组的BCVA均较术前提高,具有统计学意义(P<0.05); 治疗后3、6mo研究组BCVA提高均大于对照组,具有统计学意义(P<0.05),1mo两组间差别无统计学意义。黄斑中心凹厚度及直径3mm²圆内RPE隆起的厚度均较术前减小,具有统计学意义(P<0.05)。对于黄斑中心凹厚度及直径3mm²圆内RPE隆起的厚度,研究组下降水平均大于对照组,治疗后3、6mo均具有统计学意义(P<0.05),但治疗后1mo两组间的差别无统计学意义。所有患者均未出现不良反应。

结论：康柏西普注射可提高患者视力,降低黄斑中心凹厚度及RPE隆起的面积,与532激光合用对RVO效果较单纯药物注射更好。     

Pathogenetic mechanisms in combined cilioretinal artery and retinal vein occlusion: a reappraisal

We examined nine patients who presented cilioretinal artery occlusion (CLRAO) associated with retinal vein occlusion (RVO). CLRAO was probably secondary to the raised intraluminal resistance consequent to the RVO in patients showing initially a delayed filling of the cilioretinal artery in fluorescein angiography. Interestingly, these patients presented an ophthalmoscopically more severe form of RVO and had systemic predisposing factors for a RVO. In patients presenting a physiological perfusion of the cilioretinal artery in fluorescein angiography, RVO was a self limited disease and etiologic factors were not found. This may suggest that in these patients the CLRAO probably occurred simultaneously with the RVO after a decrease in perfusion pressure in both retinal and cilioretinal arterial systems. In this combined vaso-occlusive retinopathy the vulnerability of cilioretinal arteries can be explained either by the absence of autoregulation or by their lower perfusion pressure gradient in comparison with retinal arteries.     

10-year fundus tessellation progression and retinal vein occlusion

AIM: To access the 10-year fundus tessellation progression in patients with retinal vein occlusion. METHODS: The Beijing Eye Study 2001/2011 is a population-based longitudinal study. The study participants underwent a detailed physical and ophthalmic examination. Degree of fundus tessellation was graded by using fundus photographs of the macula and optic disc. Progression of fundus tessellation was calculated by fundus tessellation degree of 2011 minus degree of 2001. Fundus photographs were used for assessment of retinal vein occlusion. RESULTS: The Beijing Eye Study included 4403 subjects in 2001, 3468 subjects was repeated in 2011. Assessment of retinal vein obstruction and fundus tessellation progression were available for 2462 subjects (71.0%), with 66 subjects fulfilled the diagnosis of retinal vein occlusion. Of the 66 participants, 59 participants with unilateral branch retinal vein occlusion, 5 participants with unilateral central retinal vein occlusion, 1 participant with bilateral branch retinal vein occlusion, and 1 participant with branch retinal vein occlusion in one eye and central retinal vein occlusion in the other eye. Mean degree of peripapillary fundus tessellation progression were significantly higher in the whole retinal vein occlusion group (0.33±0.39, P<0.001), central retinal vein occlusion group (0.71±0.8, P=0.025) and branch retinal vein occlusion group (0.29±0.34, P=0.006) than the control group (0.20±0.26). After adjustment for age, prevalence of tilted disc, change of best corrected visual acuity, axial length, progression of peripapillary fundus tessellation was associated with the presence of retinal vein occlusion (P=0.004; regression coefficient B, 0.094; 95%CI, 0.029, 0.158; standardized coefficient B, 0.056). As a corollary, after adjusting for smoking duration, systolic blood pressure, anterior corneal curvature, prevalence of RVO was associated with more peripapillary fundus tessellation progression (P<0.001; regression coefficient B: 1.257; OR: 3.517; 95%CI: 1.777, 6.958). CONCLUSION: Peripapillary fundus tessellation progresses faster in individuals with retinal vein occlusion. This may reflect the thinning and hypoperfusion of choroid in patients with retinal vein occlusion.     

眼压在视网膜静脉阻塞中的意义

目的:探讨眼压在视网膜静脉阻塞中的意义。方法:应用TX-F眼压计对23例23眼,视网膜静脉阻塞(retinal vein occlusion,RVO)患者的眼压进行测量。对照组与病例组年龄和性别相配,例数相等。结果:18例RVO阻塞眼眼压较对侧眼有不同程度降低。RVO阻塞眼眼压显著低于对侧眼及正常对照眼(P<0.01)。结论:RVO可引起患者眼压降低。     

Establishing an experimental rat model of photodynamically-induced retinal vein occlusion using erythrosin B

AIM:To develop a reliable, reproducible rat model of retinal vein occlusion (RVO) with a novel photosensitizer (erythrosin B) and study the cellular responses in the retina.METHODS:Central and branch RVOs were created in adult male rats via photochemically-induced ischemia. Retinal changes were monitored via color fundus photography and fluorescein angiography at 1 and 3h, and 1, 4, 7, 14, and 21d after irradiation. Tissue slices were evaluated histopathologically. Retinal ganglion cell survival at different times after RVO induction was quantified by nuclear density count. Retinal thickness was also observed.RESULTS:For all rats in both the central and branch RVO groups, blood flow ceased immediately after laser irradiation and retinal edema was evident at one hour. The retinal detachment rate was 100% at 3h and developed into bullous retinal detachment within 24h. Retinal hemorrhages were not observed until 24h. Clearance of the occluded veins at 7d was observed by fluorescein angiography. Disease manifestation in the central RVO eyes was more severe than in the branch RVO group. A remarkable reduction in the ganglion cell count and retinal thickness was observed in the central RVO group by 21d, whereas moderate changes occurred in the branch RVO group.CONCLUSION: Rat RVO created by photochemically-induced ischemia using erythrosin B is a reproducible and reliable animal model for mimicking the key features of human RVO. However, considering the 100% rate of retinal detachment, this animal model is more suitable for studying RVO with chronic retinal detachment.     

中青年视网膜静脉阻塞临床分析

目的:探讨中青年视网膜静脉阻塞(RVO)的临床特点。方法:回顾分析36例36眼40岁以内中青年RVO的临床表现、类型、诊断、治疗及预后。随访时间3~24mo,观察病情演变及预后。结果:36例中视网膜中央静脉阻塞(CRVO)22例,分支静脉阻塞(BRVO)14例,其中黄斑小分支静脉阻塞(MBR-VO)2例。经应用皮质类固醇等药物治疗后多数患者症状改善,视力提高。随访中有2例视网膜出现了新生血管及无灌注区,另有2例出现了黄斑水肿,共4例接受了激光治疗。结论:中青年RVO患病率低,发病可能与炎症有关,对药物治疗的反应相对明显,一般为良性病程,预后较好。但有少数病例可出现视网膜新生血管(5.6%)及黄斑囊样水肿,需适时激光治疗。     

532nm固体激光治疗视网膜静脉阻塞

目的:观察532nm固体激光治疗视网膜静脉阻塞的疗效。方法:应用532nm固体激光治疗视网膜静脉阻塞患者45例(45眼),回顾性分析治疗前后视力及眼底血管荧光造影的变化。结果:45例视网膜静脉阻塞患者治疗后,视力提高32眼(71%);不变10眼(22%);下降3眼(7%);FFA对比观察有效36眼(80%);好转7眼(16%);无效2眼(4%);非缺血型疗效好于缺血型;BRVO好于CRVO。结论:532nm固体激光治疗RVO效果确实,操作简便,早期明确病变部位进行光凝,定期进行复查并及时补充光凝,可有效提高视力和患者生活质量。     

和血明目片治疗视网膜静脉阻塞64例

目的:观察和血明目片治疗视网膜静脉阻塞的疗效。方法:将确诊为视网膜静脉阻塞的64例患者,给予和血明目片5片/次,3次/d,连续服用45d。根据视力恢复情况、荧光血管造影、血液流变学检查以及自觉症状有无改善进行观察。结果:64例中治愈34例(53%),有效26例(41%),无效4例(6%),总有效60例(94%)。结论:和血明目片治疗视网膜静脉阻塞有显著疗效,是治疗此病的安全、简便的口服药物。     

Retino-choroidal ischemia in central retinal vein occlusion

A 41-year-old gentleman with insulin dependent diabetes had decreased vision in the right eye due to non-ischemic central retinal vein occlusion with macular edema. One month following intravitreal ranibizumab, he developed retino-choroidal ischemia with further loss of vision. Authors show the fluorescein angiographic transition from non-ischemic central retinal vein occlusion to retino-choroidal ischemia.     

缺血型视网膜静脉阻塞出血多眼光凝探讨

目的 探討出血偏多的缺血型视网膜静脉阻塞光凝方法及其疗效。方法 采用Zeiss Lumenis NOVUS OMNI多波长激光仪,利用红光、大光斑、低能量、长时间对视网膜出血偏多的缺血型分支、半侧或中央静脉阻塞并黄斑水肿患者49人52只眼实施局部或全视网膜光凝。参数：黄斑区：0.1 ～0.3秒,光斑大小50～100 μm,能量100～200 mW,中心凹1000 μm外开始,Ⅰ级光斑反应;其余区域：0.3～0.7 s,200～500μm,150～300 mw,III级光斑轻-中强度反应,如光斑反应不足,则以增长时间为主,增加能量为辅;分2～4次完成,间隔2～3周。观察视网膜出血水肿消退及视力改变等情况,随访3～30个月。结果 (1)18只眼(34.62％)首次光凝2～3周后视网膜出血水肿明显消退,其中9只眼(17.31％)视力提高,8只眼(15.39％)视力不变,1只眼(1.92％)视力下降。激光后3个月FFA证实治疗有效。(2)31只眼(59.62％)首次光凝2～3周后视网膜出血水肿部分消退,全部光凝完成后3月,眼底出血水肿完全消退,FFA证实治疗有效。其中8只眼(15.38％)视力提高;20只眼(38.46％)视力保持不变;3只眼(5.77％)视力下降。(3)3只眼新生血管性青光眼患者,病情部分改善稳定。其余患者随访期内未新发生玻璃体出血及新生血管性青光眼。结论 对出血偏多的缺血型视网膜静脉阻塞,可选用红光,使用大光斑、低能量、长时间的光凝方法,获得足够数量和强度的有效光斑,促进视网膜出血水肿吸收,减少病情恶化可能。