Retinal ischemia and risk of neovascularization following central retinal vein obstruction

The predominant risk factor for the development of neovascular complications involving the retina (NVR), the optic disc (NVD), and iris (NVI) following central retinal vein obstruction (CRVO) is the extent, location, and duration of retinal ischemia (ischemic drive). The extent of retinal capillary nonperfusion (ischemic index) was quantitated by microcomputer analysis of 200 standard fundus-iris fluorescein angiograms. The results were correlated with the development of neovascularization in eyes not receiving prophylactic argon laser panretinal photocoagulation (PRP). Of the 85 eyes with intact capillary perfusion (hyperpermeable group), none developed NVR/NVD and only one eye (1%) developed neovascular glaucoma (NVG). Twenty-nine eyes exhibited moderate degrees of retinal ischemia (indeterminate group), and three eyes (10%) developed NVR/NVD, with two eyes (7%) developing NVG. Of the 86 eyes with extensive retinal capillary nonperfusion (ischemic group), 28 eyes (33%) developed NVR/NVD and NVG occurred in 39 eyes (45%). The inherent difficulties in following high risk patients clinically and angiographically at frequent intervals over extended periods of time, the tendency for rapid progression of early NVI to NVG, and the relatively poor results following treatment in advanced cases make the early recognition of eyes at high risk to develop NVG essential and the initiation of prophylactic PRP as the treatment of choice in this disorder.     

Neovascular glaucoma following central retinal vein obstruction

The results of a prospective clinical and fluorescein angiographic study of 155 patients with central retinal vein obstruction (CRVO) were analyzed to identify risk factors contributing to the subsequent development of iris neovascularization (NVI) and neovascular glaucoma (NVG). Of 144 untreated eyes, 20% developed NVG. The eyes were classified as having either an ischemic or a hyperpermeable type of CRVO according to the extent of retinal capillary nonperfusion demonstrated by the initial fluorescein angiogram. The risk of developing NVG was found to be approximately 60% in those eyes with extensive retinal ischemia. None of the 22 eyes with an ischemic CRVO treated with panretinal photocoagulation (PRP) prior to the onset of NVI developed NVG.     

虹膜荧光素血管造影在虹膜新生血管诊断中的应用

目的 探讨虹膜荧光素血管造影(IFA)在缺血性视网膜中央静脉阻塞(CRVO)虹膜新生血管(NVI)诊断中的价值.方法 经荧光素眼底血管造影(FFA)检查确诊的CRVO患者51例51只眼纳入研究.所有患者均行视力、裂隙灯显微镜检查、眼前节彩色照相、眼压及FFA+IFA检查.根据FFA检查结果分为非缺血性和缺血性CRVO,分别为20、31只眼.非缺血性CRVO20只眼中,男性11只眼,女性9只眼;年龄41～59岁.缺血性CRVO31只眼中,男性21只眼,女性10只眼;年龄28～62岁.采用德国海德堡眼底荧光血管造影仪进行FFA+IFA检查,将典型图像存入计算机图像处理系统进行分析.对比观察裂隙灯显微镜和IFA NVI的检出率.缺血性CRVO31只眼均行全视网膜激光光凝(PRP)治疗,其中,完成治疗27只眼,未坚持完成治疗4只眼.完成治疗后6个月,随访观察NVI消退情况.结果 非缺血性CRVO20只眼裂隙灯显微镜检查瞳孔缘及虹膜未见新生血管,占100.0%;IFA检查虹膜未见显影,呈色素遮蔽荧光,占100.0%.缺血性CRVO31只眼中,裂隙灯显微镜检查显示瞳孔缘及虹膜有细小新生血管13只眼,占41.9%;IFA检查显示NVI 23只眼,占74.2%.2种检查方法NVI检出率比较,差异有统计学意义(Z=-3.425,P=0.001).IFA检查NVI分别表现为小团状、细线状或不规则交叉网状强荧光染色及渗漏.完成PRP治疗的27只眼IFA检查结果显示,瞳孔缘及虹膜表面未见荧光染色及渗漏;未坚持完成PRP治疗4只眼,1～2个月后出现新生血管性青光眼(NVG).结论 IFA可以提示眼前节的缺血状态,具有较高的特异性,辅助CRVO缺血型早期诊断,预测是否发展NVG.

Abstract：

Objective To evaluate the application value of iris fluorescein angiography (IFA) in the diagnosis of ischemic center retinal vein occlusion (CRVO). Methods Fifty-one patients (51 eyes) with CRVO which had been diagnosed by fundus fluorescein angiography (FFA) were studied. All patients underwent the examination of visual acuity, slit lamp biomicroscope, anterior segment color photography,intraocular pressure, FFA and IFA. The patients were classified as non-ischemic CRVO (20 eyes) and ischemic CRVO (31 eyes). The 20 non-ischemic CRVO patients included 11 males and nine females, aged from 41 to 59 years. The 31 ischemic CRVO patients included 21 males and 10 females, aged from 28 to 62 years. FFA and IFA were performed for all the patients using Heidelberg retina angiograph, and the classic pictures were analyzed by the computer image processing system. The detection rate of iris neovascularization (NVI) by slit lamp biomicroscope and IFA was analyzed. All ischemic CRVO eyes underwent panretinal photocoagulation (PRP), and PRP was completed in 27 eyes and not completed in four eyes. Six months after PRP the regression of iris NVI was followed up. Results All non-ischemic CRVO eyes (100. 0% ) had no neovascularization on papillary margin and iris by slit lamp biomicroscopy, and had no fluorescence (pigment blocked fluorescence) on IFA. Thirteen eyes (41.9%) and 23 eyes (74.2%) of the 31 ischemic eyes had NVI by slit lamp biomicroscope and IFA, respectively. The NVI detection rate of those two methods was statistically different (Z= - 3. 425, P = 0. 001 ). NVI showed strong fluorescence and leakage with variable patterns (small blocks, thin lines and irregular cross-links) by IFA. There was no fluorescence staining and leakage on papillary margin and iris in 27 eyes who completed the PRP, but the neovascular glaucoma (NVG) occurred in one eyes who discontinued the PRP treatment after one to two months. Conclusions IFA has a high specificity in CRVO which hints the ischemic state of anterior segment. It is helpful to the early diagnosis of ischemic CRVO and the turnover of NVG.     

早期全视网膜光凝与复方樟柳碱球后穴位注射治疗缺血性视网膜中央静脉阻塞的疗效

目的观察早期全视网膜光凝(panrentinal photocoagulation,PRP)联合复方樟柳碱球后穴位注射治疗缺血型视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)的临床疗效。方法在我院确诊为缺血型CRVO患者89例(89眼),早期行PRP和复方樟柳碱穴位注射治疗,观察治疗后3个月的视力、毛细血管灌注区变化、视网膜新生血管及并发症情况。结果治疗后观察3个月,视力提高25例(28.1%),不变56例(62.9%),下降8例(9.0%),总有效率91.0%。5例(5.6%)发生视网膜新生血管,73例(82.0%)原视网膜无灌注区消失,11例(12.4%)原视网膜无灌注区缩小>5个视盘面积,总有效率94.4%。并发黄斑囊样水肿79例,治疗后水肿减轻77例;黄斑出血10例,治疗后吸收8例。未见视盘及虹膜新生血管、玻璃体出血和新生血管性青光眼等并发症以及与治疗相关的并发症。结论早期PRP与复方樟柳碱球后穴位注射治疗缺血型CRVO是有效的、合理的中西医结合治疗方法。     

Arterial blood flow characteristics in central retinal vein occlusion and effects of panretinal photocoagulation treatment: an investigation by colour Doppler imaging

AIMS: To determine whether an increase in vascular resistance in the central retinal and ophthalmic arterial circulations contributes to the development of central retinal vein occlusion (CRVO), or haemodynamic alterations in central retinal and ophthalmic arteries occur secondary to the vein occlusion as increased intravascular pressure is transferred through the capillary bed to the arterial side and the effect of panretinal photocoagulation treatment on these circulations in ischaemic cases. METHODS: The ophthalmic and central retinal arteries of the affected and non-affected eyes of 20 patients with non-ischaemic CRVO, 13 patients with ischaemic CRVO, and 22 control subjects were investigated by colour Doppler imaging. Panretinal photocoagulation (PRP) treatment was applied to the eyes with ischaemic CRVO. Maximum and minimum blood flow velocities, and resistivity indexes were calculated in the affected and healthy eyes of patients and in the control eyes. RESULTS: Average blood flow velocity in the central retinal and ophthalmic arteries of patients with non-ischaemic CRVO did not differ from their fellow eyes, but a significantly lower average blood flow velocity was found in the ophthalmic and central retinal arteries of the patients with ischaemic CRVO compared with their fellow eyes. Patients with ischaemic CRVO had significantly lower blood flow velocities in their ophthalmic and central retinal arteries than non-ischaemic cases that were further reduced following PRP treatment. CONCLUSION: This study suggests that impaired arterial blood flow observed in patients with CRVO may be partly related to secondary changes in the retrobulbar arterial circulation as a result of enhanced arterial resistance following CRVO. These data also demonstrate that PRP treatment decreases retinal and ophthalmic blood flow velocities in patients with ischaemic CRVO.     

缺血型视网膜中央静脉阻塞行全光凝后的远期疗效观察

目的 探讨全光凝联合格栅样光凝治疗缺血型视网膜中央静脉阻塞后新生血管和黄斑水肿的远期疗效。方法 对56例(58只眼)缺血型视网膜中央静脉阻塞伴有新生血管和黄斑水肿的息眼采用全光凝和格栅样光凝进行光凝治疗。光凝后经平均随访18个月，对比分析光凝前后的荧光素眼底血管造影、视力、眼压变化情况。结果 治疗后有效45只眼，占77．6％；好转9只眼，占15．5％；治疗后视力进步者37只眼，占63．8％；无变化者15只眼，占25．9％；减退者6只眼，占10．3％。结论 全光凝和格栅样光凝术对缺血型视网膜中央静脉阻塞新生血管性青光眼的预防及黄斑水肿的消退具有显著疗效。     

Argon laser panretinal photocoagulation in ischemic central retinal vein occlusion

We conducted a prospective, planned study of argon laser panretinal photocoagulation (PRP) in ischemic central retinal vein occlusion (CRVO) over a 10-year period in 123 eyes. On comparing the lasered eyes versus the nonlasered eyes, there was no statistically significant difference between the two groups in the incidence of development of angle neovascularization (NV), neovascular glaucoma (NVG), retinal and/or optic disc NV, or vitreous hemorrhage, or in visual acuity. Our study, however, did show a statistically significant (P= 0.04) difference in the incidence of iris NV between the two groups, with iris NV less prevalent in the laser group than in the nonlaser group, butonly when the PRP was performed within 90 days after the onset of CRVO. The other parameter which showed a statistically significant difference between the two groups was the peripheral visual fields — the laser group suffered a significantly (P0.03) greater loss than the non-laser group. We discuss the implications of these findings in light of the natural history of ischemic CRVO and of ocular NV. Since the original rationale for advocating PRP in ischemic CRVO was the proven beneficial effect of PRP on ocular NV in proliferative diabetic retinopathy, we also discuss the disparities in the disease process between ischemic CRVO and proliferative diabetic retinopathy and in their responses to PRP.This investigation was supported by grant EY-1151 from the National Institutes of Health, and in part by unrestricted grants from Research to Prevent Blindness, Inc., and from the Alcon Research Institute     

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.     

Central retinal vein obstruction and carotid artery disease

Thirty-seven consecutive patients (39 eyes) with a central retinal vein obstruction (CRVO) were studied in a cross-sectional fashion with intravenous fluorescein angiography and digitial subtraction carotid angiography. Among the 35 patients (37 eyes) with acceptable studies, 24 eyes, (64%) had an ischemic CRVO, 12 (33%) demonstrated a nonischemic CRVO, and one (3%) was indeterminate. A 17% incidence of ipsilateral atherosclerotic carotid artery obstruction greater than or equal to 50% was associated with both the ischemic (4/24 eyes) and nonischemic (2/12 eyes) groups. Overall, 13 of 35 (37%) patients with CRVO had demonstrable common or internal carotid artery atherosclerosis, an incidence no higher than found in a historical control sample studied postmortem. However, this incidence rose to 50% in patients with an ischemic CRVO and decreased to 17% in those with the nonischemic variety.     

缺血型视网膜中央静脉阻塞全视网膜光凝的疗效观察

目的探讨全视网膜光凝治疗缺血型视网膜中央静脉阻塞的临床效果。方法回顾性分析2003年1月至2005年4月我院收治的缺血型视网膜中央静脉阻塞共68例68眼,其中行532 nm激光全视网膜光凝治疗40眼(激光组),28眼末行532 nm激光全视网膜光凝(对照组),观察对比两组初、末诊视力,新生血管及新生血管性青光眼等并发症情况。随访时间均在8个月以上,平均随访11±2.3个月。结果两组末次随访视力、虹膜新生血管及新生血管性青光眼等并发症发生率有所不同,但比较差异无统计学意义(P>0.05)。结论缺血性CRVO严重损害患者视力,需要积极治疗,全视网膜光凝对于对于预防虹膜新生血管及新生血管性青光眼的疗效不确切。     

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。     

Study of clinical applications and safety for Pascal® laser photocoagulation in retinal vascular disorders

Purpose: To establish safe laser parameter standards for 10–30 ms Pascal^® laser in clinical practice and to evaluate clinical and visual outcomes using this 532‐nm multi‐spot photocoagulation system. Methods: Retrospective observational case series of 313 patients treated between 2006 and 2008. Evaluation of eight groups: A – panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR); B – focal laser treatment for clinically significant diabetic macular oedema; C – grid laser for diffuse diabetic macular oedema; D – sector PRP for ischaemic branch retinal vein occlusions (I‐BRVO); E – full PRP for ischaemic central retinal vein occlusions (I‐CRVO); F – macular laser treatment for macular oedema secondary to non‐ischaemic BRVO; G – full PRP for rubeosis iridis and/or neovascular glaucoma (NVG) secondary to I‐BRVO, I – CRVO or PDR; H – laser retinopexy for retinal breaks/degenerations. Results: Mean LogMAR visual acuity for all procedures improved postlaser (p = 0.065), and laser prevented visual loss in 85% eyes. Topical anaesthesia was only required. At mean follow‐up of 5 months, 72% procedures had a successful clinical outcome. Significantly higher powers were required for PRP using Pascal^® compared to conventional laser (p = 0.001) in PDR, I‐BRVO, I‐CRVO and NVG. Sixty‐seven per cent of patients (15/20) were successfully treated with single‐session 20‐ms PRP using a mean 1952 burns. There were no laser‐associated adverse effects or ocular complications associated with multi‐spot PRP or macular Pascal^® arrays. Conclusions: The clinical efficacy using 10‐ to 30‐ms pulse duration Pascal^® laser is comparable to conventional standard protocols used for the treatment of vascular retinal disorders. Higher power, 10‐ to 30‐ms pulse duration laser may be safely and effectively used in clinical practice.     

Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion

AIM: To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion (CRVO) treated with intravitreal injections of bevacizumab, macular grid photocoagulation combined with pan retinal photocoagulation (PRP), or both (bevacizumab+grid+PRP). METHODS: Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema. Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12mo after treatment. Excluded were patients with diabetes or any other retinal disease. We reviewed the medical records of patients treated in one ophthalmology department-comparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both. The main outcome measures were the differences in best corrected visual acuity (BCVA) and in macular thickness, as assessed by optical coherence tomography, between the enrollment and the final follow up visits. RESULTS: Sixty-five patients met inclusion criteria. There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography (131.5±41.2, 108.6±29.2, and 121.1±121.1, P=0.110), or in visual acuity (0.128±0.077, 0.088±0.057, and 0.095±0.065), for intravitreal injections, macular grid photocoagulation+PRP and a combination of the treatments, respectively, P=0.111. The proportions of patients with macular edema after treatment were: 26.1%, 28.6%, and 14.3%, respectively, P=0.499. CONCLUSION: Similar benefit was observed for intravitreal injections, laser photocoagulation, or a combined regimen in the treatment of CRVO. A non-statistically significant trend for reduction in macular edema was observed following combined treatment.     

虹膜荧光素血管造影在新生血管性青光眼随访中的应用

目的　观察虹膜荧光素血管造影（iris fluorescein angiography，IFA）在新生血管性青光眼（neovascular glaucoma，NVG）随访中的作用。方法　收集2015年2月至2017年2月在北京大学第三医院随访过程中发现眼压再次升高的NVG患者17例（17眼），其中男10例（10眼），女7例（7眼），年龄（52.2±14.2）岁。视网膜中央静脉阻塞7眼，糖尿病视网膜病变7眼，视网膜分支静脉阻塞2眼，视网膜中央静脉合并动脉阻塞1眼。记录患者的最佳矫正视力、眼压、裂隙灯显微镜检查等资料。行IFA评估患者虹膜新生血管复发的情况，包括新生血管范围、荧光素渗漏程度，并与裂隙灯显微镜检查结果进行对比。结果　本研究发现，通过IFA观察到17例（17眼）患者均存在虹膜新生血管，其阳性率为100.0%；依据荧光素渗漏的情况对患者的病变进行分级，其中轻度12例12眼，中度4例4眼，重度1例1眼。裂隙灯显微镜检查结果显示12例（12眼）患者存在明显的虹膜新生血管，5例（5眼）患者未观察到明显的新生血管，其阳性率为70.6%。两种检查方法的阳性率比较差异具有统计学意义（P=0.022）。IFA所显示的新生血管范围大于裂隙灯下观察的结果。结论　IFA有助于NVG患者新生血管复发的早期诊断，在NVG随访中有十分重要的作用。     

Photocoagulation for retinal vein occlusion

The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself.Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed.In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed.The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed.Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.     

Pars plana vitrectomy and panretinal photocoagulation combined with trabeculectomy for successful treatment of neovascular glaucoma

Background Treatment of neovascular glaucoma (NVG) must be focused on the reduction of intraocular pressure (IOP) and prompt application of pan retinal photocoagulation (PRP). A combination of complete PRP during vitrectomy with trabeculectomy should theoretically be a better method to lower the IOP rapidly in eyes with NVG. The purpose of our study is to assess the efficacy of combining pars plana vitrectomy and PRP with trabeculectomy assisted by mitomycin C (MMC) on NVG eyes secondary to diabetic retinopathy.Methods Twenty-five eyes with NVG associated with diabetic retinopathy had pars plana vitrectomy, followed by PRP and trabeculectomy with MMC. The eyes were divided into two groups: nine eyes with vitreous hemorrhage, fibrovascular membrane and/or retinal detachment were placed in the Proliferation group; and 16 eyes without vitreous hemorrhage, fibrovascular membrane, or retinal detachment were placed in the PC (photocoagulation) group. These eyes had vitrectomy performed so that PRP could be safely performed from ora to ora. The surgical outcome in the two groups was assessed by Kaplan-Meier survival analysis. The criteria for success were a postoperative intraocular pressure (IOP) ≤21 mmHg and a preservation of light perception.Results In the Proliferation group, Kaplan-Meier life-table analysis showed that the success rate was 55.6% after 1 year and 18.5% after 2 years. The success rate in the PC group was 81.2% from 1 to 3 years after surgery. The surgical outcome was significantly better in the PC group than in the Proliferation group (P=0.009). In the Proliferation group, four eyes had preoperative vitreous hemorrhage, three eyes had a fibrovascular membrane, and two eyes had a retinal detachment. Three of four eyes with vitreous hemorrhage achieved good IOP control. On the other hand, the IOP of all eyes with retinal detachment and fibrovascular membrane were not lowered significantly.Conclusions Complete PRP combined with trabeculectomy with MMC can effectively reduce the elevated IOP in eyes with NVG. However, this combined treatment is not effective in eyes with proliferative membranes and retinal detachments.     

氪激光联合迈之灵治疗缺血性视网膜中央静脉阻塞的研究

目的 探讨氪离子激光联合药物迈之灵治疗缺血性视网膜中央静脉阻塞的疗效。方法 临床病例对照研究。对2006年1月至2009年1月在广西医科大学第一附属医院眼科就诊的病人,分为两组。实验组：对随机选取的30例确诊为缺血型CRVO的病人,以氪离子激光行全视网膜光凝术,并予以口服药物迈之灵进行治疗。对照组：对另外随机选取的30例确诊为缺血型CRVO的病人,予以单纯行氪离子激光全视网膜光凝术。观察两组病人治疗后眼底出血、水肿、渗出、新生血管和视力的变化情况等。结果 实验组和对照组治疗后视力改善差异无统计学意义;实验组在激光治疗的同时给予口服药物迈之灵治疗后一月复查眼底,其出血、水肿及渗出吸收情况优于对照组,差异有统计学意义;三月后复查眼底及FFA,两组眼底出血、水肿、渗出的吸收及新生血管的消退情况差异无统计学意义。结论 对于缺血性视网膜中央静脉阻塞,采用全视网膜光凝术预防和治疗新生血管是防止严重并发症的重要手段,迈之灵的联合应用可以相对缩短眼底出血、水肿和渗出的吸收时间。     

视网膜静脉阻塞患者视力预后相关因素分析

目的研究各型视网膜静脉阻塞患者的视力预后、并发症及视力降低的相关因素.方法视网膜静脉阻塞患者913例(944只眼),年龄15～89岁,平均(52.8±11.9)岁;平均随访时间20.7个月.患者所有临床资料均输入计算机,应用SPSS软件进行统计学处理.结果 (1)按部位分型总干阻塞406只眼,占43.0%;半侧阻塞60只眼,占6.4%;分支阻塞478只眼,占50.6%.(2)按缺血分型944只眼中,缺血型633只眼,占67.1%;非缺血型311只眼,占32.9%.(3)患者视力预后各型静脉阻塞患者治疗前、后视力比较,总干阻塞和半侧阻塞的差异无显著性(t=1.45,1.62;均P>0.05),分支阻塞的差异有显著意义(t=7.89,P<0.05).(4) 患者初诊视力水平与预后3种类型静脉阻塞患者视力预后均差;患者的初诊视力水平均与视力预后密切相关(χ2=175.261,21.357,106.408;均P<0.01).(5) 静脉阻塞导致的低视力和盲目率各型静脉阻塞患者的低视力与盲目率比较,差异有显著意义(χ2=85.251,P<0.01).(6) 缺血型与非缺血型患者视力预后比较视网膜静脉总干阻塞、半侧阻塞、分支阻塞患者中缺血型与非缺血型比较,差异均有显著意义(χ2=157.819,19.637,56.737;P<0.01).(7)导致静脉阻塞的危险因素高血压占57.8%,动脉硬化占67.4%,血液黏稠度增高占24.6%,原发性青光眼占1.5%,糖尿病占6.2%.(8) 静脉阻塞患者并发症的发生率黄斑囊样水肿占46.7%,视网膜和(或)视乳头新生血管占21.5%,玻璃体出血占11.4%,新生血管性青光眼占4.2%.其中总干阻塞发生新生血管性青光眼39只眼,占总干阻塞的9.6%,占半侧阻塞的1.7%.(9)并发症导致的低视力和盲目率低视力者中,黄斑囊样水肿占37.9%,新生血管占29.9%;盲目者中,黄斑囊样水肿占19.5%,新生血管占23.0%.新生血管性青光眼导致的盲目者中,视力<0.05者占95.0%.结论视网膜静脉阻塞的致盲率较高,影响视力预后的最重要因素是缺血型视网膜静脉阻塞.初诊视力水平与视力预后关系密切,黄斑囊样水肿、新生血管及新生血管性青光眼为致盲的重要原因.     

影响视网膜中央静脉阻塞预后的相关因素研究现状

视网膜中央静脉阻塞(CRVO)是常见的严重影响视力的视网膜血管病。目前雷珠单抗、阿柏西普和地塞米松植入剂等在治疗CRVO相关黄斑水肿(ME)方面取得了成功。但仍有1/3患者治疗后视力无明显改善,30.7%患者治疗后ME消退但易复发,28.1%患者治疗后始终存在ME。如何在起病初期通过患者不同的临床表现来判断其预后,有助于临床医生根据特定的疾病情况更好地为患者选择治疗方案。近年来关于CRVO治疗预后的研究主要集中在影像标志物包括视网膜内层结构紊乱、视网膜高反射灶、视网膜下液、缺血指数、渗漏指数等和生物标志物包括VEGF、白细胞介素(IL)-6、IL-8等方面。本文就影响CRVO预后的相关因素研究进展进行综述,旨在更加精准、有效地治疗、管理和监测CRVO患者。     

Early panretinal photocoagulation for ERG‐verified ischaemic central retinal vein occlusion

Purpose: We have previously shown that photopic cone b‐wave implicit time ≥35.0 ms in 30 Hz flicker electroretinography (ERG) predicts ocular neovascularization (NV) in central retinal vein occlusion (CRVO). Here, we evaluate the effects of early panretinal photocoagulation (PRP) in patients with ERG‐verified ischaemic CRVO. Methods: Patients with CRVO, admitted to our department between 2000 and 2008, were classified as having ischaemic or non‐ischaemic CRVO based on the ERG‐results. In a first group of 71 patients, 18 patients had ischaemic CRVO and were assigned to standard treatment that is regular examinations and PRP as soon as NV was found. In a consecutive group of 65 patients, 18 patients with ischaemic CRVO received early PRP. In this group, ERG was performed on average 6 weeks after the first symptoms of CRVO. The patients underwent PRP as soon as possible after the ERG‐examination, and the treatment was completed within one to three sessions. Results: Twelve patients in the standard treatment group developed neovascular glaucoma during a mean period of 5 months after the CRVO. In the early treatment group, one patient developed subtle iris rubeosis 7 months after PRP. Otherwise, none of the patients showed any signs of ocular NV, and the intraocular pressure remained within normal range, without the necessity of supplementary medication, during a mean follow‐up of 41 months. Conclusions: This study indicates that ocular NV in patients with CRVO can be predicted by photopic 30 Hz flicker ERG and that early PRP in ERG‐verified ischaemic CRVO could be suggested as standard treatment.