视网膜中央静脉阻塞的氩激光治疗

目的 探讨视网膜中央静脉阻塞的氩激光治疗疗效。方法 分析５９例（５９只眼）视网膜中央静脉阻塞的患者进行氩激光治疗的结果。结果 视网膜中央静脉阻塞患者行激光治疗后病程缩短,预后良好。结论 对于视网膜中央静脉阻塞的患者易尽早行激光治疗。     

视网膜中央静脉阻塞黄斑水肿的治疗新进展

视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)是一种常见的视网膜血管性疾病,黄斑水肿是其主要并发症也是导致视力下降的主要原因。目前临床广泛应用及研究的热点主要有激光光凝,玻璃体注药治疗:曲安奈德、血管内皮生长因子抗体,手术治疗:放射状视神经切开术等。     

多波长氪激光治疗视网膜分支静脉阻塞的疗效分析

目的:通过分析142例多波长激光治疗视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)的效果,讨论多波长激光在治疗BRVO中的重要意义。方法:通过对142例142眼BRVO患者应用美国科医人公司生产的多波长氪激光仪进行光凝治疗,在3mo后进行视力、眼压、裂隙灯、眼底镜及FFA检查,总结分析视力变化、视网膜出血吸收情况、黄斑水肿吸收情况。结果:经激光光凝治疗后3mo,出血吸收原面积的1/2以上者51眼(35.9%),吸收1/2～3/4者62眼(43.7%),吸收3/4至完全吸收者29眼(20.4%),同时,黄斑水肿完全吸收33眼(23.2%),黄斑水肿明显吸收96眼(67.6%),黄斑水肿轻度吸收或无变化13眼(9.2%)。治疗3mo后复查FFA,发现新生血管完全消退占有新生血管患者的71.2%,部分消退者占28.6%,无变化或加重仅占0.2%。结论:不失时机的应用多波长氪激光光凝治疗BRVO能明显提高视力,促进视网膜出血和黄斑水肿的吸收,同时可预防严重并发症的产生。     

激光治疗视网膜中央静脉阻塞42例

目的:探讨激光治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)的体会。方法:采用激光治疗CRVO患者42例42眼,依据眼底血管荧光造影(fundus fluorescein angiography,FFA)结果,采取不同的光凝方法进行治疗,并探讨其效果。结果:患者42眼中5眼(12%)视力提高2行以上;28眼(67%)视力无明显变化;9眼(21%)视力下降2行以上;FFA检查显示视网膜静脉迂曲扩张,视网膜出血、水肿、渗出消退,治疗有效者37眼(88%)。结论:激光对CRVO治疗有效,是控制病情发展的重要手段。     

单次玻璃体腔注射雷珠单抗联合激光治疗视网膜中央静脉阻塞继发黄斑水肿

目的观察单次玻璃体腔注射雷珠单抗联合激光光凝治疗视网膜中央静脉阻塞(CRVO)继发黄斑水肿的临床疗效。方法回顾性病例对照研究。经荧光素眼底血管造影(FFA)确诊的CRVO继发黄斑水肿患者28例(28眼),根据是否联合雷珠单抗治疗分为联合治疗组和激光治疗组。比较治疗后1、6、12个月2组患者的最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT)。应用重复测量方差分析及t检验进行统计学分析。结果 2组组间BCVA的总体差异无统计学意义(F=1. 16,P=0. 301)。2组不同随访时间BCVA的总体差异有统计学意义(F=2. 935,P=0. 039),其中联合治疗组治疗后1、6、12个月的BCVA较治疗前均有所提高,差异有统计学意义(t=3. 111、2. 677、2. 208,P=0. 009、0. 02、0. 047),而激光治疗组治疗后1、6、12个月的BCVA与治疗前比较差异无统计学意义。2组组间CMT的总体差异有统计学意义(F=4. 434,P=0. 045),其中联合治疗组治疗后1、6、12个月的CMT与同时间点激光治疗组相比,差异均有统计学意义(t=-2. 382、-3. 235、-2. 598,P=0. 025、0. 003、0. 015)。2组不同随访时间CMT的总体差异有统计学意义(F=113. 842,P <0. 01),2组治疗后1、6、12个月的CMT较治疗前均有所下降,差异有统计学意义(联合治疗组:t=5. 311、11. 574、11. 522,P <0. 01;激光治疗组:t=8. 037、8. 818、9. 322,P <0. 01)。结论单次玻璃体腔注射雷珠单抗联合视网膜激光光凝治疗可有效减轻CRVO继发黄斑水肿,提高患者的视力,其减轻黄斑水肿作用较单纯激光治疗更加明显。     

玻璃体手术治疗视网膜中央静脉阻塞伴黄斑水肿

目的 观察玻璃体手术治疗视网膜中央静脉阻塞(CRVO)伴黄斑水肿的临床疗效.方法 取临床诊断为缺血性CRVO伴黄斑水肿的连续病例36例(36眼).根据手术时间先后分为放射状视神经切开术(RON)组和玻璃体切除与周边视网膜光凝术(PPV/PE)组,随访(28.6±6.3)个月.对比观察各个时段的视力、视野、黄斑中心凹厚度及眼底改变情况.结果 1个月内RON组4只眼视力提高,PPV/PE组6只眼视力提高.1年以上追踪观察RON组8只眼视力提高,4只眼视力不变,2只眼视力下降,PPV/PE组12只眼视力提高.8只眼视力不变,4只眼视力下降,两组最好矫正视力均无≥0.5,≥0.1者占50%.两组1个月及一年时段视力提高≥0.1者对比差异无统计学意义(P>0.05),两组对黄斑中心凹的视网膜厚度经OCT测量均有持续明显的减轻.RON组4只眼视神经切开部位萎缩.结论 对于缺血性CRVO伴黄斑水肿的玻璃体手术的治疗,从视力改变及黄斑水肿减轻的角度出发,RON组和PPV/PE组无明显区别,且RON存在着视神经萎缩的并发症.临床应首选简单易行的PPV/PE手术.     

氪黄激光治疗缺血型视网膜中央静脉阻塞黄斑水肿的疗效

目的 观察氪黄激光治疗缺血型视网膜中央静脉阻塞黄斑水肿的疗效.方法 2007年3月至12月在我科经眼底荧光造影(fundus fluorescein angiography,FFA)和光学相干断层扫描(optic coherent tomography,OCT)检查确诊为缺血型视网膜中央静脉阻塞并伴有黄斑水肿,接受黄斑区氪黄激光栅格样光凝联合无灌注区氪绿激光光凝治疗的患者45例(45眼),观察其在治疗后1个月、3个月、6个月时的视力、FFA及OCT检查结果的变化.结果 随访1个月时,视力提高9眼,稳定24眼,下降12眼;FFA检查无明显渗漏11眼,渗漏缩小24眼,渗漏无明显变化10眼;OCT检查水肿减轻12眼,水肿无明显变化20眼,水肿加重13眼.3个月时.视力提高23眼,稳定14眼,下降8眼;FFA检查无明显渗漏17眼,渗漏缩小23眼,渗漏无明显变化5眼;OCT检查水肿减轻27眼,水肿无明显变化15眼,水肿加重3眼.6个月时,视力提高26眼,稳定15眼,下降4眼;FFA检查无明显渗漏37眼,渗漏缩小6眼,渗漏无明显变化2眼;OCT检查水肿减轻41眼,水肿无明显变化3眼,水肿加重1眼.结论 氪黄激光栅格样光凝治疗缺血型视网膜中央静脉阻塞黄斑水肿疗效显著.     

玻璃体手术治疗视网膜中央静脉阻塞伴黄斑水肿

Objective To observe the clinical therapeutic effects of vitrectomy and radial optic neurotomy (RON) for macular edema secondary to central retinal vein occlusion (CRVO). Methods Thirty-six consecutive patients (36 eyes) were identified duration of macular edema secondary to ischemic CRVO. According to the time of surgery, these patients divided into two groups, the radial optic neurotomy (RON) group, the Pars Planna Vitrectomy/Panretianl Endophotocoagulation (PPV/PE) group. The average follow-up periods were 28.6± 6.3 months. The changes in visual acuity (VA), foveal thickness, visual fiPEd and the case of optic disc were observed and compared. Results The visual acuity (VA) of 4 eyes in the radial optic neurotomy (RON) group and 6 eyes in the Pars Planna Vitrectomy /Panretiani Endopbotocoagulation (PPV/PE) group improved at the first 1 month. Then clinical observation and follow-up more than 1 year, in the radial optic neurotomy (RON) group: visual acuity (VA) had improvement in 8 eyes, 4 remained the same, whereas 2 became worse. The Pars Planna Vitrectomy/Panretianl Endopbotocoagulation (PPV/PE) group: visual acuity (VA) had improvement in 12 eyes, 8 remained the same, whereas 4 became worse. None of both the groups were≥0.5 in BCVA, and 50% were ≥0.1. It was not statistically significant between the two groups which eyes were≥ 0.1 in BCVA at 1 month and 1 year of follow-up (P >0.05 ). OCT showed that all patients were improved at their last follow-up when compared with preoperative foveal thickness. However,4 eyes had optic atrophy in RON group. Conclusions The improvement in visual acuity and macular edema between RON group and PPV/PE group has no statistically significant differences. However, optic atrophy is a major postoperative complication in the RON group. It's better to choose PPV/PE first.     

玻璃体手术治疗视网膜中央静脉阻塞伴黄斑水肿

Objective To observe the clinical therapeutic effects of vitrectomy and radial optic neurotomy (RON) for macular edema secondary to central retinal vein occlusion (CRVO). Methods Thirty-six consecutive patients (36 eyes) were identified duration of macular edema secondary to ischemic CRVO. According to the time of surgery, these patients divided into two groups, the radial optic neurotomy (RON) group, the Pars Planna Vitrectomy/Panretianl Endophotocoagulation (PPV/PE) group. The average follow-up periods were 28.6± 6.3 months. The changes in visual acuity (VA), foveal thickness, visual fiPEd and the case of optic disc were observed and compared. Results The visual acuity (VA) of 4 eyes in the radial optic neurotomy (RON) group and 6 eyes in the Pars Planna Vitrectomy /Panretiani Endopbotocoagulation (PPV/PE) group improved at the first 1 month. Then clinical observation and follow-up more than 1 year, in the radial optic neurotomy (RON) group: visual acuity (VA) had improvement in 8 eyes, 4 remained the same, whereas 2 became worse. The Pars Planna Vitrectomy/Panretianl Endopbotocoagulation (PPV/PE) group: visual acuity (VA) had improvement in 12 eyes, 8 remained the same, whereas 4 became worse. None of both the groups were≥0.5 in BCVA, and 50% were ≥0.1. It was not statistically significant between the two groups which eyes were≥ 0.1 in BCVA at 1 month and 1 year of follow-up (P >0.05 ). OCT showed that all patients were improved at their last follow-up when compared with preoperative foveal thickness. However,4 eyes had optic atrophy in RON group. Conclusions The improvement in visual acuity and macular edema between RON group and PPV/PE group has no statistically significant differences. However, optic atrophy is a major postoperative complication in the RON group. It's better to choose PPV/PE first.     

视网膜中央静脉阻塞的治疗现状

视网膜中央静脉阻塞是仅次于糖尿病性视网膜病变的常见视网膜血管病,常导致视力下降甚至失明,以往视网膜激光光凝术、手术、玻璃体腔注药等疗法对视网膜中央静脉阻塞的治疗有一定疗效,近年来一些新方法如抗新生血管内皮生长因子、地塞米松缓释剂以及联合治疗等的出现,取得较好效果,但更安全有效的治疗措施有待进一步研究.     

Differential analysis of aqueous humor cytokine levels in patients with macular edema secondary to diabetic retinopathy or retinal vein occlusion

AIM: To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy (DR) or retinal vein occlusion (RVO).METHODS: This is a retrospective case control study. The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor (VEGF) for patients diagnosed with macular edema secondary to DR (DME) or RVO (RVO-ME) at Xijing Hospital from August 2021 to July 2022. Meanwhile, aqueous humor samples during vitrectomy from patients with idiopathic macular hole (IMH) were also collected and served as controls. The aqueous humor concentrations of VEGF, platelet-derived factor (PDGF), interleukin (IL)-6, IL-8, IL-18, tumor necrosis factor-α (TNF-α) and monocyte chemoattractant protein 1 (MCP-1) were measured with Human Premixed Multi-Analyte Kit (Luminex). The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS: A total of 40 eyes of 38 patients were enrolled in the study, including 13 eyes of 11 DME patients (DME group), 16 eyes of 16 RVO-ME patients (RVO-ME group) and 11 eyes of 11 IMH patients (control group). The VEGF, PDGF, IL-6, IL-8, and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group (all P<0.05), the levels of TNF-α was higher in the DME group than in the control group (P<0.05). The VEGF, IL-6, MCP-1, and TNF-α levels in the aqueous humor were significantly higher in the DR group than those in the RVO group (all P<0.05). Correlation analyses revealed that there were complex positive correlations between IL-6, IL-8, IL-18, MCP-1, and TNF-α levels in the aqueous humor of eyes with two diseases.CONCLUSION: Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME, the roles of these factors are more significant or more likely to be activated in DR patients, suggesting different treatment strategies should be considered for the two diseases.     

多波长激光治疗糖尿病性黄斑水肿

目的　探讨多波长激光治疗糖尿病性黄斑水肿的临床疗效。方法　对 5 0例 (80眼 )患有糖尿病性视网膜病变和黄斑水肿的 型糖尿病患者进行多波长激光治疗 ,其中非增殖期糖尿病性视网膜病变 2 5例 4 2眼 ,增殖期糖尿病视网膜病变 2 5例 38眼。治疗中 ,黄斑区治疗 ,以黄光治疗为主 ,包括局灶性光凝和弥漫性格栅样光凝。周边光凝则以黄绿混合光、绿光或红光进行治疗。在一些复杂的病例治疗中 ,则采用几种波长激光随时切换使用 ,达到以最低能量最低损害 ,产生有效光斑和最大治疗效果的目的。结果　本组病例治疗前视力均值为 0 .36± 0 . 2 9,光凝后的视力均值为 0 .4 7± 0 .31,P<0 .0 5 ,光斑水肿消减率达 71.2 5 % .非增殖期糖尿病性视网膜病变的视力提高或不变值为 92 .85 % ,增殖期糖尿病视网膜病变者为 76 .31% ,P<0 .0 5。结论　多波长激光治疗黄斑水肿有效 ,且早期治疗效果好 ,氪黄激光治疗糖尿病性黄斑水肿疗效较好。     

雷珠单抗治疗视网膜静脉阻塞的临床研究

目的 观察玻璃体内注射雷珠单抗(Ranibizumab)联合视网膜激光光凝治疗合并黄斑水肿的视网膜静脉阻塞(retinal vein occlusion,RVO)的疗效.方法 2013年10月至2015年3月我院确诊为RVO患者32例35眼纳入研究,分为视网膜分支静脉阻塞(branch retinal vein occlusion,BRVO)组18例(19眼)、视网膜中央静脉阻塞(cranch retinal vein occlusion,CRVO)组14例(16眼).所有患者均接受Ranibizumab玻璃体内注射,采用1+PRN方案.在初次注射后0.5～1个月,联合视网膜激光光凝治疗.比较两组患者治疗前、治疗后患眼黄斑中心视网膜厚度(macular central retinal thickness,CRT)、国际标准糖尿病早期治疗研究(Early treatment diabetic retinopathy study,ETDRS)视力表、裂隙灯、眼底镜、眼压以及眼底荧光血管造影检查(fluorescein fundus angiography,FFA).结果 随访2～6个月,平均4个月.CRVO组、BRVO组重复注射Ranibizumab的次数分别为(1.83±0.83)次、(1.58±0.67)次.CRVO组、BRVO组治疗前后ETDRS视力比较差异均有统计学意义(t=3.237、6.178,均为P＜0.05),CRVO组、BRVO组治疗前后CRT差异均有统计学意义(t=3.165、3.598,均为P＜O.05).两组术后CRT与年龄、糖尿病、高血压因素均无相关性(r =0.114、0.435、0.028、0.269、0.171、0.062,均为P＞0.05).BRVO组术前CRT及注射次数有相关性(r =0.556,P≤0.05).结论 经玻璃体内注射Ranibizumab联合视网膜激光光凝治疗RVO能促进出血吸收、改善黄斑水肿并且提高视力.两组末次随访CRT与年龄、合并糖尿病、合并高血压因素均无相关性.BRVO组研究结果显示IVR联合视网膜激光治疗疗效优于IVR单项治疗.     

氩激光治疗视网膜中央静脉阻塞的时机探讨

目的:探讨氩激光治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)的时机。方法:根据CRVO发病后至接受激光治疗的时间不同分为3组,A组为CRVO发生后4~8wk共23例23眼,B组为CRVO发生后12~16wk共9例9眼,C组为CRVO发生20wk以后共6例6眼。激光治疗方法分为黄斑区格栅样光凝,局灶性视网膜光凝及全视网膜光凝。结果:2a后A组视力>0.3者为17眼占74%;B组视力>0.3者为4眼占44%;C组视力>0.3者仅1眼占17%,2例发展成为新生血管性青光眼(NVG)。结论:CRVO发生后早期光凝治疗对视力的恢复有较好的效果,晚期光凝治疗主要是预防并发症的发生。     

去炎松玻璃体内注射治疗视网膜中央静脉阻塞引起的黄斑水肿37例

目的:评估去炎松玻璃体内注射治疗视网膜中央静脉阻塞造成的黄斑水肿效果。方法:中央视网膜静脉阻塞(CRVO)并发黄斑水肿患者37例(37眼)接受玻璃体腔注射去炎松(40g/L,0.1mL,1～3次)治疗。非缺血性CRVO33眼,缺血性CRVO4眼,注射1次20眼,注射2次15眼,注射3次2眼,平均随访时间9(3～27)mo。患者从症状出现至一次注射药物平均时隔时间为2.7(0.3～9)mo。注射前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影(FFA)和中央黄斑厚度光相干断层扫描(OCT)检查。结果:治疗前平均视力为0.08(0.01～0.4)。注射后1～3mo,最佳矫正视力提高25眼,无变化3眼,视力下降9眼,在视力提高患眼中,视力提高3行以上12眼,视力提高2行10眼,提高1行3眼。此后,部分视力下降和视力未提高患者,进行2次或3次注射,最终随诊时视力提高24眼,视力无变化3眼,视力下降10眼,在视力提高的患眼中,视力提高3行以上8眼,视力提高2行10眼,提高1行6眼,整个治疗前后平均视力增加2～3行。治疗后1～3mo时,间接眼底镜检查黄斑水肿完全消退16眼,水肿明显减轻19眼,水肿加重2眼。最终随诊时,间接眼底镜检查黄斑水肿完全消退19眼,减轻17眼,加重1眼。15眼在注射药物后1wk～6mo期间先后出现不同程度的高眼压达35.4(25.1～40.1)mmHg(1mmHg=0.133kPa),13眼进行降眼压治疗,其中4眼接受抗青光眼手术。在32只晶状体眼中,出现了晶状体后囊膜下混浊的并发性白内障9眼,进行白内障摘除4眼。OCT检查发现玻璃体腔注射药物治疗后黄斑厚度减少,中央黄斑平均厚度减少至注射前厚度的46%。4眼没有视力的提高。结论:玻璃体腔内注射去炎松是一种治疗视网膜中央静脉阻塞引起黄斑水肿的有效方法。对于缺血性中央视网膜静脉阻塞患者视力不会提高。     

放射状视神经切开术治疗缺血型视网膜中央静脉阻塞伴黄斑水肿的疗效评估

目的评估放射状视神经切开术（RON）治疗缺血型视网膜中央静脉阻塞（CRVO）伴黄斑水肿的效果。方法回顾性分析2005～2007年行RON治疗的18例缺血型CRVO伴明显黄斑水肿患者的临床资料,其中15例术前确诊为缺血型CRVO,3例玻璃体积血手术后确诊为缺血型CRVO。手术前后均进行视力、荧光素眼底血管造影（FFA）、光相干断层扫描（OCT）检查。术后随访1周,1、3、6个月,比较患者手术前后的检查结果。所有患者在应用药物或手术前均签署知情同意书。结果除3例病程太长或黄斑变性视力未恢复,其余15例视力在短期内均有不同程度的提高,视力恢复〈3个月组好于〉3个月组（p=0．025）。眼底照相、OCT及FFA检查结果显示黄斑水肿均在1个月内明显消退,眼底出血3个月内吸收。1例术中穿刺视盘时出现鼻侧视网膜下局限性出血。结论RON能够改善缺血型CRVO合并的黄斑水肿。早期手术干预视力预后较好。术中联合应用的黄斑内界膜剥离术所起的作用尚需进一步评估。     

曲安奈德联合激光光凝治疗视网膜静脉阻塞继发黄斑水肿

目的：观察玻璃体腔内曲安奈德( trialcinolone acetonide, TA)注射联合黄斑格栅样光凝治疗视网膜静脉阻塞引起黄斑水肿的疗效分析。
　　方法：检眼镜、眼底血管造影( FFA )、光学相干断层扫描( OCT)检查证实的由视网膜静脉阻塞引起的黄斑水肿患者35例35眼,玻璃体内注射TA 2lg,1~4wk内黄斑水肿减轻后行黄斑格栅样光凝,随访6lo,观察视力、眼压、晶状体,OCT 观察黄斑厚度改变,FFA 观察眼底毛细血管渗漏情况。
　　结果：视网膜中央静脉阻塞( central retinal vein occlusion, CRVO)中非缺血型10眼,缺血型14眼;视网膜分支静脉阻塞( branch retinal vein occlusion, BRVO)中非缺血型4眼,缺血型7眼。最终视力提高者19眼,不变者11眼,比术前降低者5眼。 OCT检查黄斑中心凹形态恢复正常者9眼,FFA提示黄斑区荧光素渗漏与术前相比消失或明显减轻;黄斑囊样水肿明显改善者21眼,FFA 提示渗漏比术前减轻;无改善者5眼,FFA 提示黄斑区渗漏比术前加重或不变。
　　结论：玻璃体腔内注射TA 2 lg联合黄斑格栅样光凝治疗视网膜静脉阻塞继发黄斑水肿,可以明显减轻由静脉阻塞引起的黄斑水肿,并提高患者视力,是一种有效可行的方法。