全视网膜光凝治疗不同阶段缺血型视网膜中央静脉阻塞的疗效分析

目的：评价全视网膜光凝（PRP）治疗对不同阶段缺血型视网膜中央静脉阻塞（CRVO）的疗效。方法2011年6月至2014年4月来上海交通大学医学院附属仁济医院眼科门诊通过视功能、裂隙灯、扩瞳眼底及眼底荧光血管造影（FFA）检查诊断为缺血型CRVO的患者,根据激光治疗时是否存在虹膜新生血管（INV）将患者分为无INV的A组（34眼）和已出现INV的B组（7眼）。所有患者均接受PRP治疗,并根据病情变化和FFA的结果在随访中予补充光凝。随访6个月～3年,平均（19.3±8.5）个月,观察PRP在减少和预防缺血型CRVO严重并发症及光凝等方面的差异。结果 A、B两组患者在发病年龄上差异无统计学意义（P＞0.05）。经PRP治疗后, B组患者最终的激光次数和总光凝点数均显著多于A组（P＜0.05）;B组患者新生血管性青光眼（NVG）的发生率较高（P＜0.05）,但两组间的玻璃体出血（VH）的发生率差异无统计学意义（P＞0.05）;两组患者在治疗前后的视力差异无统计学意义（P＞0.05）。结论本研究提示缺血型CRVO患者在没有出现INV之前进行PRP,最终严重并发症的发生率相对较低,所需光凝次数和点数均较少。     

Intra‐arterial thrombolysis of central retinal artery occlusion following percutaneous atrial septal defect closure

Use of percutaneous devices for atrial septal defect (ASD) closure is growing, given the minimally invasive nature and the long‐term durability of this approach. The reported rate of thrombus formation after catheter closure is 1.2%. Thrombotic risk varies according to closure device and Dacron‐covered nitinol Amplatzer devices carry a 0‐0.3% rate of thrombus formation; but central retinal artery occlusion (CRAO) is rarely implicated as an adverse event. Herein, we report the first successful intra‐arterial thrombolytic treatment of CRAO developing after ASD closure via Amplatzer device. © 2015 Wiley Periodicals, Inc.     

A case of polyarteritis nodosa complicated by left central retinal artery occlusion,ischemic optic neuropathy,and retinal vasculitis

A 23-year-old single female patient developed constitutional manifestations in the form of fever, weight loss, anorexia, malaise, fatigue, and generalized aches in January 1995, 2 weeks after an attack of German measles. This was followed by painful, reddish, macular skin lesions over both legs which healed by dark pigmentation (leucocytoclastic vasculitis), mononeuritis multiplex, and Raynaud’s phenomena of both hands and feet. Angiography of lower limbs was done to visualize the arterial tree of both lower limbs and revealed typical beading of distal arterial branches, a diagnosis compatible with polyarteritis nodosa (PAN). At that time, the patient received prednisone (45 mg/day) and azatioprin (100 mg/day) and responded well to treatment. In a second presentation in June 2005, the patient developed sudden attack of loss of vision in her left eye. Ophthalmological examination of the patient revealed evidence of left central retinal artery occlusion, ischemic optic neuropathy. The patient received methyl prednisolone, 1 g IV infusion, daily infusion for three consecutive days followed by oral prednisolone, 30 mg/day. The patient received pulse cyclophosphamide IV infusion (0.6 g/m²) on the fourth day. One week after receiving therapy, the patient progressed from having light perception to counting of fingers from a distance of 1 m.     

Comparative efficacy and safety of antivascular endothelial growth factors for central retinal vein occlusion: A protocol for systematic review and network meta-analysis

Background:Central retinal vein occlusion (CRVO) is one of the most common retinal vascular diseases, which is closely related to systemic diseases like hypertension, diabetes and arteriosclerosis. Due of its blinding, it will seriously reduce the quality of life. Macular edema (ME) caused by CRVO is one of the serious complications of visual impairment. We found that the severity of ME in CRVO was positively associated with vascular endothelial growth factor (VEGF) in the anterior chamber. With the accelerated pace of modern life and the changed dietary structure, the incidence of this disease will continue to rise. Therefore, it is of great practical significance to seek effective treatment methods. Intraocular injection of anti-VEGF can effectively alleviate ME and improve visual acuity, showing excellent clinical application prospects. In recent years, there have been some new understandings and advances on the etiology and treatment methods of the present disease, such as the deepening into the molecular biology and gene level. Clinical studies on the efficacy of the disease have emerging. Therefore, a network meta-analysis (NMA) of anti-VEGF treatment for CRVO is particularly necessary to systematically compare its efficacy.Methods:The two reviewers will comprehensively retrieved electronic databases such as PubMed, The Cochrane Library, Wanfang database, Web of Science, Chinese Scientifific Journals Database, EMBASE, China National Knowledge Infrastructure, and China BioMedical Literature. A randomized controlled trial for CRVO against VEGF between January 2010 and June 2021 was included according to the relevant content of the study. In addition, 2 researchers will screen the literature to assess the risk bias for the included articles. We will evaluate the collected evidence and data using a Bayesian NMA method, and analyzed it with STATA and WinBUGS software.Results:Anti-VEGF is one of the effective methods for ME in CRVO patients, accordingly, this study will evaluate its efficacy and safety using a Bayesian NMA system.Conclusion:This study can provide an effective rationale for the clinical application of anti-VEGF for CRVO, contribute to the treatment of CRVO and patient condition rehabilitation in clinical work.Ethics and dissemination:Do not require.INPLASY registration number:INPLASY2021110073.     

Coronary artery disease, cerebral non-fatal ischemic stroke in retinal vein occlusion: An 8-yr follow-up

Forty-five consecutive subjects (26M, 19F; mean age 54 ± 14 yrs) with a diagnosed retinal vein occlusion (RVO), were followed-up for 8 yrs. As many as 145 sex-age- and blood pressure-matched individuals (78M, 67F; mean age 54.4 ± 13.5 yrs), that did not experience any vascular event, served as controls. At the time of the RVO, controls and subjects did not differ as to hypercholesterolemia, hypertrigliceridemia, diabetes mellitus, smoking habits, inherited/acquired thrombophilia. At the follow-up completion, they differed as to statin consumption (p = 0.016). During the 8-yrs follow-up, in the control population, 11 out of 145 (7.6%) subjects had experienced a major vascular event (8 coronary artery disease; 3 cerebral non-fatal ischemic stroke). In contrast, of the 45 subjects with a history of RVO, as many as 10 (22.2%) had experienced a major vascular event: 4 coronary artery disease; 4 cerebral non-fatal ischemic stroke; 2 cardiovascular + cerebrovascular event (p = 0.012). A prolonged antiplatelet treatment, prior to the major vascular event, was found in 5/45 cases (11.1%) vs 23/145 (15.9%) controls (p = 0.63). In contrast, a long-lasting administration of anti-hypertensive drugs, to achieve a control of blood pressure, was found in 83.4% of controls and only in 46.7% of cases (p < 0.0001). In conclusion, in a 8-yr follow-up, coronary artery disease and/or non-fatal ischemic stroke were more common in subjects with a history of RVO than in a large setting of subjects comparable for cardiovascular risk factors. These data also argue for RVO as a vascular disease in which aggressive anti-hypertensive therapy to prevent stroke and/or myocardial infarction is needed.     

Impact of retinal vein occlusion on cardiovascular events in elderly Japanese patients

To assess the relationship between retinal vein occlusion (RVO) and the incidence of cardiovascular (CV) events.This was a single-institution, retrospective cohort study. We enrolled 57 patients diagnosed with RVO between January 2012 and December 2019, and 125 non-RVO patients who had undergone cataract surgery by a single surgeon between January and April 2012. We compared the relative risk and incidence rate ratio of CV events between the 2 groups. In addition, survival analysis was performed to calculate the hazard ratio (HR) using the Cox proportional hazards model. RVO, age, sex, blood pressure, body mass index, presence of diabetes, blood sample data, and smoking were considered confounders.The mean observation period (± standard deviation) for the RVO and non-RVO groups was 2.68 ± 2.04 and 2.81 ± 2.70 years, respectively. Seven CV events were observed in the RVO group and 2 in the non-RVO group. Relative risk and incidence rate ratio were 7.68 (95% confidence interval [CI]: 1.65–35.8) and 8.07 (95% CI: 1.54–79.6), respectively. Multivariate analysis revealed that the RVO group had a high HR for CV events (HR: 16.13 [95% CI: 2.29–113.74]) and older age (HR: 1.26 [95% CI: 1.06–1.49]).RVO can predict future CV events, especially in the elderly population. Fundus observations should be shared between ophthalmologists and internists to prevent future CV events.     

Central retinal vein occlusion and cerebellar infarction complicating systemic lupus erythematosus: a case report

We treated a 17-year-old woman who had systemic lupus erythematosus (SLE) complicated by central retinal vein occlusion (CRVO) and bilateral cerebellar infarction in the absence of demonstrable antiphospholipid antibodies. General fatigue, diffuse polyarthralgia, malar rash, and fever had developed during the 2 weeks preceding admission. The patient was diagnosed with SLE based on the presence of pleuritis, oral ulceration, pancytopenia, and antinuclear antibodies. Despite intravenous pulse therapy with methylprednisolone, blindness developed in the left eye and bilateral cerebellar infarcts were evident on magnetic resonance images. Fluorescein angiography revealed extensive retinal venous thrombosis leading to widespread retinal vein leakage, and a diagnosis of CRVO. Received: May 15, 2000 / Accepted: January 15, 2001     

Anterior chamber bevacizumab for rubeotic glaucoma secondary to retinal artery occlusion

A 73-year-old Caucasian female, presented with sudden loss of vision in the right eye due to a central retinal artery occlusion (CRAO). The patient presented acutely 10-weeks later with a painful right eye due to rubeosis; intraocular pressure (IOP) was 67 mmHg. A single anterior chamber injection of bevacizumab was performed as an adjunct combination therapy for her neovascularisation. Informed consent to the patient included a detailed explanation of the medication licensing status. 1-week post injection the cornea was clear and there was less rubeosis. Pan-retinal photocoagulation (PRP) was performed and 1 month later there was a marked reduction in rubeosis iridis. At 6 months follow up the patient remains comfortable on prednisolone acetate 1% OD and atropine 1% OD; IOP is 24. As the main trigger for such neovascularisation is retinal ischaemia, the incidence of rubeosis in CRAO is relatively low. Successful combination treatment of rubeosis following CRAO with a single intravitreal injection of anti-VEGF followed by PRP has been reported. In our opinion anterior chamber injection of anti-VEGF may be less invasive than intravitreal delivery. Although there are emerging reports regarding the successful use and efficacy of the anterior chamber route of administration for the treatment of rubeosis from venous occlusion, no such reports have been published following CRAO.     

Revascularization of a central vein total occlusion via antegrade and retrograde approach in a patient with hemodialysis access

The occurrence of central vein total occlusion results in upper arm edema, pain, and hemodialysis access failure in uremic patient. Previous studies have proven the effectiveness of percutaneous balloon angioplasty for central vein total occlusion. Here, we report a rare case of successful revascularization of central vein total occlusion via antegrade and retrograde approach. © 2010 Wiley‐Liss, Inc.     

Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports

Rationale:In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine.Patient concerns:Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment.Diagnoses:Case1: Temporal superior BRVO and secondary ME were observed in the left eye. Her best-corrected visual acuity (BCVA) was 20/30.Case2: Temporal superior BRVO recurrence and secondary ME were observed in the right eye. BCVA was 20/25.Interventions:Case1: Additional dose of IVA was administered. Case2: Two times of Intravitreal ranibizumab was administered twice.Outcomes:Case1: Subsequently, ME resolved BCVA was 20/20. Case2: Subsequently, ME resolved BCVA was 20/25.Lessons:Both cases showed a possible association between SARS-CoV-2 vaccination and the exacerbation of BRVO.     

Platelet activation by ADP is increased in selected patients with anterior ischemic optic neuropathy or retinal vein occlusion

To investigate whether adenosine diphosphate (ADP)-induced platelet hyperaggregability is associated with nonarteritic anterior ischemic optic neuropathy (NAION) or retinal vein occlusion (RVO).

We retrospectively reviewed thrombophilia screening data of patients with NAION or RVO without a history of arterial hypertension, diabetes mellitus, hyperlipidemia, obesity, and cigarette abuse. Patients with a positive family history for thromboembolism were not excluded. Platelet aggregation (area under the curve, AUC) after induction of 0.5, 1.0, and 2.0 µmol of ADP was estimated in 25 NAION and RVO patients and compared with 25 healthy controls.

We observed significantly greater platelet aggregation post 0.5 (P = 0.002) and 1.0 (P = 0.008) µmol of ADP among NAION and RVO patients compared with healthy controls. Platelet hyperaggregability was significantly more prevalent in patients than in controls (56% vs. 8%; P = 0.0006).

Our results suggest that in NAION and RVO patients without a history of arterial hypertension, diabetes mellitus, hyperlipidemia, obesity, and cigarette abuse, platelets are significantly hyperreactive after induction of very low concentrations of ADP when compared with healthy individuals. This hyperreactivity is particularly evident in patients with a family history of thromboembolism.     

27G玻璃体切除术治疗视网膜分支静脉阻塞继发玻璃体积血的临床疗效和安全性探讨

目的探讨27G玻璃体切除术治疗视网膜分支静脉阻塞继发玻璃体积血的临床疗效及安全性。方法回顾性分析27G玻璃体切除治疗视网膜分支静脉阻塞所致玻璃体积血患者33例(33眼)的临床资料,术后随访1个月。对比术前、术后1周和1个月的最佳矫正视力(best corrected visual acuity,BCVA)和眼压变化,记录玻璃体切除时间、切口缝合和渗漏情况,术中及术后并发症等情况。结果玻璃体切除平均时间为(16.30±4.10)min。术后1周和1个月术眼的BCVA均较术前提高,差异有统计学意义(P均<0.01),术后1个月较术后1周的BCVA有提高,差异有统计学意义(P<0.05)。术眼术前、术后1周和1个月的平均眼压分别为(16.39±3.46)mmHg(1 mmHg=0.133 kPa)、(15.37±2.32)mmHg和(16.69±2.45)mmHg,差异无统计学意义(P>0.05)。所有患眼术毕均无需缝合巩膜穿刺口。术中发生视网膜医源性裂孔1眼。随访期间发生高眼压2眼,低眼压1眼,经合理处理后眼压均恢复正常。其余患者在术中和术后随访均未见眼部或全身不良反应。结论采用27G玻璃体切除术治疗视网膜分支静脉阻塞继发的玻璃体积血是安全有效的,少有术中及术后并发症。     

Hypertension as a risk factor for retinal vein occlusion in menopausal women: A nationwide Korean population-based study

Retinal vein occlusion (RVO) is an important cause of blindness. Hypertension is a well-known risk factor for RVO. Although the prevalence of hypertension increases in women after menopause, the relationship between blood pressure and RVO in women before and after menopause has not been studied in detail.We retrospectively analyzed 2,619,206 patients from the Korean National Health Insurance System database. A Cox proportional hazard regression model was used to evaluate the independent association between blood pressure and the risk of RVO development and identify differences between premenopausal and postmenopausal women.The incidence of RVO was higher among postmenopausal women than in premenopausal women. In the model adjusted for socioeconomic and clinical variables, there was an association between blood pressure and RVO development in premenopausal and postmenopausal women; however, this was stronger than premenopausal women.Both systolic and diastolic blood pressure are associated with an increased risk of RVO, and their effects are more potent in premenopausal women than postmenopausal women. Thus, comprehensive management of hypertension in premenopausal women is essential to reduce the risk of RVO.     

Low vitamin B6 and folic acid levels are associated with retinal vein occlusion independently of homocysteine levels

Retinal vein occlusion (RVO) is one of the most common retinal vascular disorders. During the last years, high levels of homocysteine (Hcy) have been demonstrated to be an independent risk factor for RVO. Aim of this study was to investigate the association among circulating B-group vitamins, Hcy and RVO. Thus, we studied 262 RVO patients and 262 age- and sex-comparable healthy subjects. Serum vitamin B6 was measured by HPLC, serum folic acid and vitamin B12 by radioimmunoassay and plasma Hcy by FPIA.

Blood levels of vitamin B6, folate and Hcy, but not of vitamin B12, were found to be significantly different in patients as compared to healthy subjects. At the univariate analysis, the lowest tertile of vitamin B6 [odds ratio (OR) 4.03; 95% confidence interval (CI) 2.58–6.31; P < 0.0001)] and folate (OR 6.13; 95% CI 3.85–9.76, P < 0.0001), and the highest tertile of Hcy (OR 8.08; 95% CI 5.05–12.92, P < 0.0001) were found to be significantly associated with RVO. Moreover, at multivariate analysis, after adjustment for traditional cardiovascular risk factors, Hcy, and circulating levels of vitamins, respectively, the lowest tertile of vitamin B6 (OR 3.29; 95% CI 1.89–5.70, P < 0.0001) and folate (OR 5.41; 95% CI 3.08–9.51, P < 0.0001) and the highest tertile of Hcy (OR 2.58; 95% CI 1.12–5.94, P < 0.0001) maintained their significant association with RVO. In conclusion, the present study documents, on a large sample of patients, that low vitamin B6 levels, low folic acid levels and elevated Hcy levels are each independently associated with RVO.     

Antithrombotic treatment of retinal vein occlusion: a position statement from the Italian Society on Thrombosis and Haemostasis (SISET)

Retinal vein occlusion (RVO) represents a common cause of visual impairment and blindness. RVO may be associated with both local (e.g., hyperopia, glaucoma) and systemic (e.g., hypertension, diabetes, smoking, obesity, and dyslipidaemia) risk factors. The association with thrombophilia remains controversial. Data on the use of antithrombotic therapy for RVO are poor and inconsistent with most of the information being derived from observational studies. Here we provide a position statement from the Italian Society on Thrombosis and Haemostasis (SISET) to guide the clinical and therapeutic management of patients with RVO based on the available evidence and expert opinion.     

雷珠单抗治疗老年患者视网膜静脉阻塞继发黄斑水肿的临床观察

目的分析玻璃体腔注射雷珠单抗对老年视网膜静脉阻塞(RVO)继发黄斑水肿(ME)患者的疗效。方法回顾性研究2018年1月—2019年12月,复旦大学附属华东医院眼科收治的37例(37眼)老年RVO继发ME确诊患者。所有患者均接受3+PRN治疗方案,玻璃体腔注射雷珠单抗。分别于治疗前和治疗后1、3、6个月时,检测患者最佳矫正视力(BCVA);通过光学相干断层扫描分析患眼黄斑中心凹视网膜厚度(CMT)、黄斑区平均视网膜厚度(MMT)及黄斑中心体积(CMV)的变化情况。结果与治疗前比较,治疗后1、3和6个月患者的平均BCVA改善(χ²=37.70,P<0.05),CMT(F=22.06,P<0.01)及MMT变薄(F=30.75,P<0.01),CMV减小(F=27.57,P<0.01)。研究期间2例患者出现球结膜下出血,未见其他严重不良反应。结论玻璃体腔注射雷珠单抗治疗能一定程度上提高老年RVO继发ME患者的视力,减轻ME,有助于恢复患者的视网膜正常结构。     

Transluminal Nd: YAG laser embolysis for branch retinal artery occlusion: Case report

Rationale:Central retinal artery occlusion and branch retinal artery occlusion (BRAO) result in partial or complete retinal ischemia and sudden loss of vision; to date there is no effective therapy for central retinal artery occlusion and BRAO. Transluminal Nd:YAG laser embolysis (TYE) could represent a therapeutic approach for retinal vascular occlusive diseases.Patient concerns:We report 2 cases with BRAO, 1 with inferor-temporal and 1 with superor hemiretinal BRAO. All the patients complained of a history of sudden blurry vision and impaired visual field and had a visible embolus within the intravascular, all of them treated with TYE, the laser applications being delivered directly to the embolus.Diagnosis:The diagnosis was based on the results from color retinography, optical coherence tomography and visual field testing. Fundus fluorescein angiography clearly indicated the location of retinal artery occlusion.Interventions:The patients’ symptoms could not be relieved after dilating the blood vessels in the eye, lowering intraocular pressure, massaging the eyeball, and inhaling oxygen. Informed consent was obtained from the patient for TYE and the patients were referred for this procedure.Outcomes:Upon the successful competition of the TYE procedure the embolus was removed completely, restoring the blood flow in the intraocular vessels and improving significantly the patients’ visual acuity.Lessons:World-wide experience with TYE is still limited, but the technique seems feasible for the treatment of RAO caused by visible emboli on the optic disc surface and the posterior pole of the fundus oculi.     

Autogenous vein graft from iliac artery to splenic artery for celiac occlusion in pancreaticoduodenectomy

This is a report of two patients with bile duct cancer and periampullary cancer with celiac axis occlusion who underwent pylorus-preserving pancreaticoduodenectomy and pancreaticoduodenectomy, respectively. Preoperative arteriography demonstrated complete obstruction of the celiac axis. The arterial blood flow to the liver, spleen, and stomach was sustained through the pancreaticoduodenal arcades and collaterals from the superior mesenteric artery. Therefore, reconstruction of the celiac axis circulation was required before division of the gastroduodenal artery. An autograft of the saphenous vein was placed between the iliac artery and the splenic artery, and subsequently pancreaticoduodenectomy was performed. The patients' postoperative courses were uneventful. Postoperative arteriography demonstrated patency of the grafts. When occlusion of the celiac axis exists, a bypass from the iliac artery to the splenic artery using a saphenous vein graft, may be safely and easily performed at the time of pancreaticoduodenal resection.