视网膜黄斑分支静脉阻塞的临床观察和中心凹无血管区面积的测定

目的 观察视网膜黄斑分支静脉阻塞(macular branch retinalve in occlusion, MBRVO)眼的临床特点以及黄斑中心凹无血管区(foveal avascular zone,FAZ)面积的改变。 方法 回顾分析检眼镜、Goldmann三面镜和裂隙灯显微镜及荧光素眼底血管造影(fundus fluorescein angiography,FFA)等检查确诊的MBRVO患者69例69 只眼的临床资料，观察分析阻塞处动静脉的位置关系、眼底及FFA特点和并发症等临床特征。并对其中36例病程3~6个月的MBRVO患者及30名正常对照者采用Heidelberg 激光扫描眼底荧光造影系统测定的FAZ面积资料进行对比分析。 结果 69例MBRVO 发生于黄斑上支者45只眼，占65.22%，黄斑下支者24只眼，占34.78%。阻塞处动脉多位于静脉之上，眼底及FFA检查可见4种不同的临床类型,主要的并发症为黄斑水肿。 MBRVO患者的FAZ面积较正常人明显扩大（P＜0.05)。 结论 MBRVO有其自身特点，临床表现多样，FAZ的面积较正常人明显扩大。（中华眼底病杂志，2003，19：269-332）     

视网膜黄斑分支静脉阻塞黄斑无血管区图像定量研究

视网膜黄斑分支静脉阻塞(macular branch retinal vein occlusion ,MBRVO)临床上较为少见,在视网膜分支静脉阻塞中占19.5%,由于视网膜水肿侵犯黄斑,因此视力受累比较严重.为了探讨MBRVO视力损害的机制,我们对30例MBRVO的黄斑无血管区变化及相关因素进行了观察分析,报告如下.     

视网膜黄斑分支静脉阻塞

本文报告黄斑分支静脉阻塞４４例，分析了该病的临床表现和视力预后。黄斑分支静脉阻塞与主干分支静脉阻塞相同，恒发生在动，静脉交叉处。本组阻塞点处动脉位于静脉之上者占９３．０２％，阻塞部位以位于黄斑等第二分支者最多占５９．１％，。     

视网膜黄斑中心凹无血管区的解剖研究

目的 应用共焦激光扫描显微镜观察及研究黄斑中心凹毛细血管拱环、中心凹无血管区（foveal avascular area, FAZ）的大小及其与年龄增长的关系。 方法 32只尸体眼黄斑部视网膜分离后，应用IV型胶原抗体对视网膜血管进行免疫染色，采用共焦激光扫描显微镜观察结果，分析FAZ的面积、直径与年龄的关系。 结果 清晰地观察到旁中央凹毛细血管网。FAZ的平均面积（0.24±0.13）mm²，平均直径（0.54±0.15）mm。FAZ的面积、直径与年龄无明显相关关系。 结论 共焦激光扫描显微镜与免疫染色法可清晰显示黄斑中心凹毛细血管拱环。FAZ的大小与年龄无明显关系。黄斑部毛细血管拱环完整性可能不受年龄影响。（中华眼底病杂志，2003，19：73-75）     

视网膜血管病中黄斑中心凹无血管区的研究进展

黄斑中心凹无血管区（FAZ）是指视网膜连续毛细血管丛所包围的区域,其本身没有任何毛细血管结构。FAZ是形成精细视觉功能的重要区域,其形态及周围毛细血管密度的变化反映了黄斑的缺血程度,且与糖尿病视网膜病变、视网膜静脉阻塞、Coats病、特发性黄斑毛细血管扩张症、早产儿视网膜病变等视网膜血管病密切相关。应用光相干断层扫描血...     

激光光凝治疗对视网膜分支静脉阻塞和黄斑静脉阻塞视网膜血管直径的影响

目的：研究成功视网膜静脉阻塞光凝治疗对不同直径视网膜血管对光凝治疗的反应和作用。 方法：研究包括14例静脉分支阻塞或黄斑静脉阻塞患者。眼科检查包括最佳矫正视力、活体显微镜检查、眼底照相和荧光眼底血管造影。在激光治疗术前和术后，应用一种视网膜血管分析仪测量视网膜血管直径。     

视网膜分支静脉阻塞的临床研究任重道远

视网膜分支静脉阻塞由多种因素联合作用引起,目前缺乏有效治疗手段。治疗前视力可能是重要的预后因素。黄斑格栅光凝、眼内注射曲安奈德（triamcinolone acetonide,TA）或抗血管内皮生长因子（vascular endothelial growth factor,VEGF）以及玻璃体手术是目前用于治疗视网膜分支静脉阻塞继发黄斑水肿的主要方法,但均存在一定的局限性和并发症。     

黄斑分支静脉阻塞荧光血管造影分析

目的：分析视网膜黄斑分支静脉阻塞(MBRVO)的荧光造影改变和临床特点。方法：收集90例91只眼MBRVO患者的荧光造影照片，分析黄斑分支静脉阻塞的部位及特点。结果：MBRVO旧占同期分支静脉阻塞的14．0％；阻塞部位以黄斑颓上支多见，占71．4％；动静脉交叉呈正交叉者为98．9％；黄斑水肿发生率为93．4％；出现缺血改变占16．5％；对侧眼出现静脉阻塞者为5．5％。结论：MBRVO的发病与MBRVO的病因及受累部位相似，视力预后取决于其并发症的程度及范围。     

视网膜分支静脉阻塞视网膜微血管改变的定量研究

【摘要】 目的 研究视网膜分支静脉阻塞（BRVO）患者视网膜微血管改变的特点。设计 病例对照研究。研究对象 河北省邯郸市眼科医院连续的BRVO患者58例,对照组为“邯郸眼病研究”中按匹配原则抽取的非BRVO者200例。方法 对被研究者的眼底彩色照片定性判读视网膜微血管局部改变;利用计算机辅助软件（IVAN software, Australia）定量测量视网膜微血管管径,比较两组间的差异。主要指标 视网膜微血管局部改变包括局部视网膜动脉缩窄（FAN）、视网膜动静脉交叉压迫征（AVN）和动脉反光增强（OPAC）。定量测量指标为视网膜中央动脉直径（CRAE）、视网膜中央静脉直径（CRVE）和视网膜动静脉比值（AVR）。结果 CRAE、CRVE、AVR在BRVO组和非BRVO组分别为（136.0±20.7） μm Vs. （152.0±19.3） μm（P=0.000）;（207.2±23.1） μm Vs. （235.3±29.7） μm（P=0.000）;（0.66±0.13） Vs. （0.65±0.06）（P=0.019）。经多因素校正后视网膜血管局部改变FAN、AVN和OPAC在两组间比较的相对危险度分别为5.65（95%CI=1.77~18.03）、3.42（95%CI=1.48~7.89）和3.44（95%CI=1.44~8.24）（P均<0.05）。结论 视网膜动、静脉直径在BRVO者比非BRVO者均变窄,视网膜血管的局部改变在BRVO者比非BRVO者显著,因此视网膜血管的定量、定性分析可作为BRVO的观察指标。（眼科,2012,21：239-243）     

Foveal avascular zone in macular branch retinal vein occlusion

The mean area of the foveal avascular zone (FAZ) in normal subjects was reported as 0.231 mm² to 0.405 mm², using fluorescein angiography. The FAZ enlarges in vaso-occlusive diseases, especially diabetic retinopathy, sickle cell retinopathy, talc retinopathy and branch retinal vein occlusion.In the present study the FAZ of 20 patients affected by macular branch retinal vein occlusion (MBRVO) was compared with the FAZ of 41 control subjects. The FAZ mean area was 0.56 ± 0.34 mm² SD in the MBRVO group, while 0.26 ± 0.07 mm² SD in the control group, with a statistically significant difference (p < 0.001). The FAZ mean perimeter was 4.77 ± 1.90 mm SD in the MBRVO group, and 2.36 ± 0.32 mm SD in the control group, with a statistically significant difference (p < 0.001). Taking into account the MBRVO group, a statistical correlation was found between visual acuity impairment and FAZ enlargement (p = 0.02), but not between visual acuity impairment and macular edema (p = 0.41). In 14 cases (70%) secondary avascular microzones located in the macular sector correspondent to MBRVO were also evident. MBRVO causes an irregular enlargement of the FAZ which seems to represent the most important feature related to visual acuity impairment.     

Horseshoe-like macular tear following recurrent branch retinal vein occlusion

Background A macular hole can develop as a late complication secondary to a branch retinal vein occlusion (BRVO). We report about an atypical horseshoe-like tear occurring in the fovea after recurrent BRVO. Methods An interventional case report. Results In 1997, a 53-year-old man was seen with an occlusion of macular part of inferior temporal vein of the retina on the left eye. After experiencing several recurrent BRVO in this eye, 6 years later he presented with a horseshoe-like tear in the fovea. Visual acuity was 20/200. The patient underwent standard three-port vitrectomy and installation of C3F8 16%. Intraoperatively, massive traction of the vitreous was detected on the edges of the tear. Six months after the operation, the tear remained attached. The visual acuity was 20/200. Conclusions The uniqueness of the presented case is the occurrence of a macular tear following recurrent BRVO, its horseshoe-like shape and foveal location. To the best of our knowledge, this is the first report on a horseshoe-like tear seen in the fovea secondary to BRVO. We assume that chronic macular edema and retinal ischemia following BRVO were additional factors beside the vitreous traction, contributing to the formation of the macular tear. Anatomical closure of the tear and stabilisation of visual acuity can be achieved by vitreoretinal surgery. There is no financial interest to declare. No grant has been received in relation to this case. Presented as a poster at the 102nd meeting of the German Ophthalmologic Society, 2004 Berlin.     

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）     

Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of or 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.     

Transient increase in macular edema following vitrectomy for retinal branch vein occlusion

Purpose We confirmed a transient increase in macular edema in some patients after simple vitrectomy for macular edema associated with branch retinal vein occlusion (BRVO). Methods We studied 54 consecutive patients (54 eyes) with macular edema secondary to BRVO and preoperative visual acuity of 0.5 or below, who underwent vitrectomy and were followed for at least 1 year. Visual acuity and foveal retinal thickness measured by optical coherence tomography were determined before and after vitrectomy. Results The patients were divided into two groups according to whether there was a postoperative increase in foveal retinal thickness. In group A (11 eyes; 20.3%), a significant increase in foveal retinal thickness was observed at 1 month after surgery, but there was no significant change in visual acuity. In group B (43 eyes; 79.6%), there was no transient increase in retinal thickness, and visual acuity improved while foveal retinal thickness decreased gradually by 1 year after surgery. In group A, macular edema had improved significantly at 3 months after surgery without local injection of triamcinolone acetonide (TA), and visual acuity and foveal retinal thickness at 1 year after surgery did not differ significantly from those in group B. Multiple regression analysis was conducted to identify the preoperative factors associated with transient increase in macular edema, and no significant factor was detected. Conclusions When simple vitrectomy is conducted for macular edema associated with BRVO, a transient postoperative increase in macular edema occurs in some cases, but resolves spontaneously without TA injection. Further study is required to determine whether this transient increase in macular edema is a phenomenon that occurs after vitrectomy for diseases accompanied by macular edema.     

视网膜分支静脉阻塞致黄斑水肿的视网膜地形图

目的 使用光学相干断层成像仪（OCT）的视网膜地形图观察视网膜分支静脉阻塞（BranchRetinalVeinOcclusion,BRVO）所致黄斑水肿的图像特征,监测黄斑水肿的变化,探讨BRVO所致黄斑水肿患者黄斑中心凹1mm直径范围（黄斑中心凹区）视网膜厚度与最佳矫正视力之间的关系.方法 使用OCT对17人17眼发病后3个月以内、继发于BRVO的黄斑水肿患者行视网膜地形图检查,对图像进行分类并随访观察,将初诊时黄斑中心凹区视网膜厚度与最佳矫正视力进行相关分析.结果 根据黄斑水肿范围及程度的不同将黄斑水肿的视网膜地形图分为3种类型,视网膜地形图对黄斑水肿的轻微变化非常敏感,黄斑中心凹区视网膜厚度与最佳矫正视力呈负相关.结论 OCT的视网膜地形图可有效地观察BRVO所致黄斑水肿的范围及程度,并可用于监测黄斑水肿的发展以及治疗后水肿的变化,早期BRVO（发病后3个月以内）所致黄斑水肿患者黄斑中心凹区视网膜厚度与最佳矫正视力呈负相关.     

One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion

Background  To investigate the long-term effectiveness of intravitreal bevacizumab treatment in eyes with perfused macular edema due to branch retinal vein occlusion (BRVO). Methods  In this prospective interventional case series, 23 consecutive, previously untreated eyes with perfused macular edema were treated with intravitreal bevacizumab (1.25 mg) injections and followed for 1 year. The main outcome measures were visual acuity (VA) and central retinal thickness (CRT). In addition, VA data were adapted to the non-logarithmic VA charts used in the previously published grid laser photocoagulation BRVO Study. Results  The median VA gained 3.0 lines from baseline at 48 weeks. This was accompanied by a significant decrease of 39% of the median CRT. The mean number of re-injections was 1.6 during the first 6 months of follow-up and only 0.8 during the subsequent 6 months. In 65% of the cases, adapted VA data showed a gain of 1 or more lines and no eye lost more than 1 line. Conclusions  Repetitive intravitreal bevacizumab injections result in a significant long-term improvement of VA and CRT. The number of re-injections necessary to maintain this effect declined over time. However, the treatment seems to be only slightly better than grid laser photocoagulation. Gesine B Jaissle, Martin Leitritz: These authors contributed equally to the work. The study has been supported by the German Ophthalmological Society (DOG). The authors have no financial disclosures. The authors declare no conflicts of interest. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.     

Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion

PURPOSE: To evaluate the prognostic factors for visual outcome after intravitreal bevacizumab injection to treat macular edema due to branch retinal vein occlusion (BRVO). METHODS: Fifty eyes of 50 consecutive patients treated with intravitreal bevacizumab for macular edema due to BRVO with minimum follow-up of 3 months were retrospectively reviewed. Patients were categorized into two groups according to the final visual acuity. Group 1 consisted of eyes with 5 or more ETDRS letters gain, and group 2 consisted of eyes with less than 5 letters improvement or which had worsened at last follow-up visit. Comparative clinical and fluorescein angiographic characteristics were analyzed between the two groups. RESULTS: Of 50 eyes, 28 (56%) had improved vision after intravitreal bevacizumab injections and were categorized as group 1; 22 eyes (44%) were categorized as group 2. The number of early VA gainers, who showed visual improvement at 1 month after bevacizumab injection, was significantly higher in group 1 (P < 0.001, chi-square test). The early gainers tend to maintain significantly better visual outcome until last follow-up. The number of eyes with angiographically documented macular ischemia was significantly higher in group 2 (P < 0.001). In group 2, the decrease in central macular thickness was not accompanied by visual acuity improvement. CONCLUSION: Preoperative presence of macular ischemia can be useful in predicting the outcome of visual acuity after intravitreal bevacizumab for macular edema due to BRVO. The early gainers who favorably responded to the initial intravitreal bevacizumab injection are most likely to benefit from the bevacizumab treatment.