Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Retinal vein occlusion (RVO)-including central RVO, branch RVO, and hemicentral and hemispheric RVO—is the second most common vascular cause of visual loss, surpassed only by diabetic retinopathy. The presence and extent of retinal ischemia in RVO is associated with a worse prognosis. On this basis, most previously conducted studies considered ischemic retinal vein occlusion (iRVO) and non-iRVO as separate entities based on set thresholds of existing retinal ischemia as determined by fundus fluorescein angiography. Other diagnostic technologies have been used specifically in the differentiation of ischemic central retinal vein occlusion and nonischemic central retinal vein occlusion. To date, there is no fully accepted definition for iRVO. Some clinicians and researchers may favor establishing a clear differentiation between these forms of RVO; others may prefer not to consider iRVO as a separate entity. Whatever the case, retinal ischemia in RVO confers a higher risk of visual loss and neovascular complications; thus, it should be determined as accurately as possible in patients with this disease and be considered in clinical and experimental studies. Most recently conducted clinical trials evaluating new treatments for macular edema secondary to RVO included none or only few patients with iRVO based on previous definitions (i.e., few patients with sizeable areas of retinal ischemia were recruited in these trials), and thus it is unclear whether the results observed in recruited patients could be extrapolated to those with retinal ischemia. There has been scant research aiming at developing and/or testing treatments for retinal ischemia, as well as to prevent new vessel formation as a result of RVO. We provide a detailed review of the knowledge gathered over the years on iRVO, from controversies on its definition and diagnosis to the understanding of its epidemiology, risk factors and pathogenesis, the structural and functional effects of this disease in the eye and its complications, natural history, and outcomes after treatment. In each section, the definition of iRVO used is given so, independently of whether iRVO is considered a separate clinical entity or a more severe end of the spectrum of RVO, the information will be useful to clinicians to determine patient's risk, guide therapeutic decisions, and counsel patients and for researchers to design future studies.     

Management of macular oedema due to retinal vein occlusion: An evidence-based systematic review and meta-analysis

Background

Central retinal vein occlusion and branch retinal vein occlusion are common causes of visual loss due to associated macular oedema. The aim of this review was to assess the effectiveness of interventions improving vision and treating macular oedema in central retinal vein occlusion and branch retinal vein occlusion.

Methods

Medical search engines and clinical trial registries were systematically searched. Randomised clinical trials with ≥90 eyes and real-world outcome studies with ≥100 eyes each with ≥6 months follow-up were included.

Results

There were 11 randomised controlled trials evaluating treatments for central retinal vein occlusion which met the inclusion criteria and 10 for branch retinal vein occlusion. There were 10 real world outcome studies of central retinal vein occlusion and 5 real world outcome studies of branch retinal vein occlusion. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were change in visual acuity at 6-, 12-, 24- and 36 months by treatment.

Conclusions

Intravitreal anti-vascular endothelial derived growth factor is recommended as first line treatment over intravitreal corticosteroid due to its effectiveness and lower rate of ocular adverse events. Best outcomes are achieved when intravitreal treatment is started early. Macular laser may have an adjunctive role in branch retina vein occlusion but not central retinal vein occlusion.     

视网膜分支静脉阻塞的临床分析

目的 为了了解视网膜分支静脉阻塞患者的合并症发生的情况。 方法 回顾性地分析本院1995年10月到1999年10月277例（277只眼）视网膜分支静脉阻塞的病例。 结果 70%以上的病例发病年龄均在55岁以上，81.58%的分支静脉阻塞发生于颞上及颞下象限。分支静脉阻塞合并症的发生率与阻塞的位置密切相关，愈大的分支静脉阻塞，其无灌注区及新生血管的发生率也就愈高。 结论 视网膜分支静脉阻塞黄斑水肿发生在发病的早期，无灌注区的出现多在7～12个月，而新生血管的出现，多半在一年以后，因此对这些患者应当有更长期的追踪观察。 （中华眼底病杂志，2002，18：17-19）     

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。     

视网膜静脉阻塞的危险因素分析

目的 分析视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)和视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)的危险因素;并对CRVO和BRVO危险因素进行直接比较.方法 对46例CRVO(CRVO组)、33例BRVO(BRVO组)与79例老年性白内障或屈光不正患者(对照组)行危险因素和血脂谱分析,并对比观察.结果 多元线性回归分析结果显示:高同型半胱氨酸血症(P＜0.000 1)、高总胆固醇(P=0.003 0)、高脂蛋白a(P =0.027 0)、高血压(P =0.022 0)、短眼轴(P ＜0.000 1)与CRVO显著相关;而高同型半胱氨酸血症(P＜0.0001)、高总胆固醇(P =0.008 0)、高血压(P=0.002 0)、高体质量指数(P=0.004 0)、短眼轴(P=0.001 0)与BRVO相关.一元线性回归分析示CRVO和BRVO上述危险因素比较没有明显差别.结论 CRVO、BRVO危险因素包括系统(高血脂、高血压、高同型半胱氨酸)和眼部(短眼轴)的多种因素,但是这些危险因素在CRVO和BRVO之间没有显著差异.     

视网膜静脉阻塞的预后分析

对近年来关于视网膜静脉阻塞预后的研究进展进行综述，包括影响视网膜静脉阻塞预后的相关因素，各种治疗措施对其预后的影响及判断预后的辅助检查方法。认为临床中应积极防治并发症，争取患者最佳预后视力。     

同型半胱氨酸与视网膜静脉阻塞

视网膜静脉阻塞是一种常见的视网膜血管性疾病,为多因素致病,目前对其病因还不能系统而准确的了解。近年来,对高同型半胱氨酸血症与视网膜静脉阻塞关系的研究有了较大进展,但结果仍存在争议。     

Central retinal vein occlusion: a review

Central retinal vein occlusion remains a common cause of unilateral visual loss. Until recently, our treatment options for this condition were limited only to laser photocoagulation for the devastating end sequelae of anterior segment neovascularization. Over the last 2 years, a number of randomized controlled trials have given us significant new treatment options to address not only visual loss from macular oedema but also the ability to create a bypass around the obstruction in the central retinal vein and to address the raised venous hydrostatic pressure. In the future, it is likely that combination approaches to the management of central retinal vein occlusion will develop using specific agents and techniques to address the components of macular oedema, retinal ischaemia and raised venous hydrostatic pressure, all of which combine to produce the clinical picture and the reduction in vision seen in this condition.     

视网膜静脉阻塞的治疗进展

我们从药物治疗、激光治疗和手术治疗等3个方面阐述了视网膜静脉阻塞的治疗近况,并提出了视网膜静脉阻塞未来治疗的展望。     

视网膜静脉阻塞的治疗进展

视网膜静脉阻塞是临床上常见的视网膜疾病,常因严重的并发症致视力下降甚至盲目,到目前尚无针对病因的确切有效的治疗方法。随着对该病发病机制的认识以及眼科技术的发展,国内外学致力研究的方法在动物实验和临床试验都取得了一定成效。     

视网膜静脉阻塞的治疗趋势

视网膜静脉阻塞是仅次于糖尿病视网膜病变的常见视网膜血管病,在疾病的认识史上,它“古老”而“陌生”。致病的多因素及其慢性积累、突然发作,是此病重要特点。目前,在其病因、自然病程和治疗方面仍存在很多争议。眼科治疗的目的主要是控制黄斑水肿、新生血管形成等并发症。抗VEGF疗法的持续应用与玻璃体内注射曲安奈德以及视网膜光凝等联合疗法,形成了目前的治疗趋势。     

视网膜静脉阻塞动物模型的制作

视网膜静脉阻塞是临床上常见的视网膜疾病,常因严重的并发症导致视力下降甚至失明,位于致盲性视网膜血管病的第二位,随着对本病的重视,国内外学者制作数种动物模型,进行病因、病理学和治疗学上的研究。本文综述了视网膜静脉阻塞动物模型制作的现状,其中包括光化学法、激光光凝法、经玻璃体眼内电凝视网膜静脉法、凝血酶静脉滴注法和玻璃体内注入内皮素-1法等;并探讨各种动物模型中,动物来源是否易获得,是否容易饲养,管理;模型制作的可操作性及与人体机能、代谢形态相似性。     

Adult Coats' disease in branch retinal vein occlusion

We report a case of adult Coats disease secondary to a branch retinal vein occlusion. Angiograms show the relationship of the peripheral telangiectasis, aneurysm formation and vascular incompetence to the peripheral retinal ischaemia. The possible role of vascular remodelling in the pathogenesis of this uncommon complication of a common condition is discussed.     

视网膜静脉阻塞致病机制浅析

视网膜静脉阻塞(retinal vein occlusion,RVO)起病是由一系列多原因多因素共同作用参与的,其明确的致病机制仍未明了,我们就近年来国内外对RVO发病机制的研究进行综述。     

北京城乡人群视网膜静脉阻塞患病情况调查

目的了解北京城区和农村中老年人群视网膜静脉阻塞(RVO)的患病情况及流行病学特征。设计人群为基础的横断面研究。研究对象"北京眼病研究"40岁以上人群4439人(应答率83.4%),农村1973人,城市2466人。方法对每位受检者进行详细的眼科检查包括散瞳后彩色眼底照相。依据眼底照片表现诊断RVO。主要指标RVO患病率。结果RVO患病率为1.3%(58/4335,95%CI:1.0%～1.6%)。RVO患病率随年龄的增长而增加(P<0.001)。城市(1.4%,95%CI:0.9%～1.9%)和农村(1.3%,95%CI:0.8%～1.8%)患病率无统计学差异(P=0.400)。男性(1.3%,95%CI:0.8%～1.8%)和女性(1.4%,95%CI:0.9%～1.9%)患病率无统计学差异(P=0.578)。右眼和左眼患病率无统计学差异(0.8%/0.6%,P=0.195)。视网膜分支静脉阻塞占91.4%,视网膜中央静脉阻塞占8.6%。双眼RVO仅2例。RVO导致的单眼低视力及盲占本研究中单眼低视力及盲总人数的4.5%和2.1%。结论40岁以上者视网膜静脉阻塞的患病率为1.3%。患病率随年龄增长而增加,无性别及城乡差异。     

视网膜静脉阻塞的研究进展

视网膜静脉阻塞(RVO)是一种常见的视网膜血管病变性疾病,其致盲率仅次于糖尿病视网膜病变,由此造成的黄斑水肿、新生血管性青光眼等严重损害了患者的视功能,甚至造成永久的、不可逆的视力下降。近年来,随着大量学者对RVO的进一步研究探讨,对其发生发展又有了更加深入的认识。本文对RVO的发病机制、视力预后的影响因素和治疗的研究进展进行综述。     

正确看待视网膜静脉阻塞的各种治疗

本文对目前视网膜静脉阻塞的各种治疗方法，包括激光光凝、激光脉络膜视网膜吻合术、动静脉鞘膜分离术、放射状视神经切开术、内界膜剥离术、玻璃体腔内注射曲安奈德等，就其疗效、并发症、作用机制等方面进行了评述。