康柏西普联合全视网膜激光光凝治疗CRVO继发新生血管性青光眼

目的：探讨康柏西普联合全视网膜激光光凝(panretinal photocoagulation,PRP)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发新生血管性青光眼(neovascular glaucoma,NVG)的疗效。

方法：本组观察对象为2014-05/2017-05于我院眼科治疗的CRVO继发NVG患者100例100眼,现回顾性分析其病历资料,将采用青光眼滤过性手术联合PRP治疗的50例患者设为对照组,在此治疗基础上加用玻璃体腔注射康柏西普的50例患者设为观察组。比较术前、术后7d,1、3、6mo最佳矫正视力(best corrected visual acuity,BCVA),并采用非接触式眼压计比较各时期眼压,裂隙灯检查新生血管消退情况并结合眼压等判断手术效果,随访6mo记录术后复发率及并发症发生情况。

结果：两组患者术后1、3、6mo BCVA趋于稳定,术后BCVA与术前比较,组间各时间点比较差异无统计学意义(P>0.05); 两组术后7d,1、3、6mo眼压均显著低于术前,术后7d,1mo观察组显著低于对照组,差异有统计学意义(P<0.05),术后3、6mo组间比较差异无统计学意义(P>0.05); 观察组手术成功率为100%,与对照组(92%)比较差异具有统计学意义(P<0.05),观察组手术完全成功率为84%,显著高于对照组(66%), 差异有统计学意义(P<0.05); 观察组前房出血及复发率显著低于对照组,差异有统计学意义(P<0.05),两组患者浅前房、低眼压发生率差异无统计学意义(P>0.05)。

结论：术前玻璃体腔注射康柏西普联合PRP治疗CRVO继发NVG眼压恢复时间更短,手术效果更优,能控制前房出血并降低复发率。     

Neovascular response in ischaemic central retinal vein occlusion after panretinal photocoagulation.

Twenty seven eyes treated for ischaemic central retinal vein occlusion with panretinal photocoagulation were reviewed. Prior to laser therapy anterior segment neovascularisation predominated (17 eyes) over posterior segment involvement (6 eyes). After photocoagulation anterior segment new vessels regressed or did not develop in the majority of cases. However, in five eyes previously absent posterior segment neovascularisation occurred. These results suggest that photocoagulation alters but does not eliminate retinal ischemia, thus modulating the neovascular response.     

Efficacy of panretinal photocoagulation in central retinal vein occlusion

This retrospective study reviews the efficacy of panretinal photocoagulation in the prevention and management of ocular neovascularization in 55 cases of central retinal vein occlusion. Differentiation of occlusions into ischemic and nonischemic forms is of critical importance, with aggressive laser treatment being warranted in the ischemic variety. The presence of ocular neovascularization may not necessarily imply a grim prognosis.     

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.     

Xenon arc panretinal photocoagulation for central retinal vein occlusion: a randomised prospective study.

Thirty-three patients with central vein occlusion were evaluated for the effects of scatter xenon arc panretinal photocoagulation. Thirty-four eyes (2 eyes of 1 patient) were randomly divided into a treatment (15 eyes) and a nontreatment group (19 eyes). The average follow-up per eye has been 29 months. The visual prognosis was not significantly better in either group. There was no difference in the development of fundus neovascularisation between groups. None of the patients in the treated group developed rubeosis or neovascular glaucoma. Two patients in the nontreatment group initially had rubeosis and 3 developed it after entry. All 5 involved eyes developed neovascular glaucoma. A significantly greater amount of central retinal capillary drop-out was present in the untreated eyes that developed rubeosis than those untreated eyes which did not. The eyes in the treated group had a similar range of capillary drop-out area, but none of these eyes developed rubeosis or neovascular glaucoma. Panretinal photocoagulation prevented the development of rubeosis and neovascular glaucoma in susceptible eyes.     

光凝预防视网膜中央静脉阻塞新生血管性青光眼

目的 评价广泛视网膜光凝预防缺血犁视网膜中央静脉阻塞新牛血管性青光眼的临床效果.方法 为前瞻性随机对照临床研究,共60例(60只眼)经眼底荧光素血管造影证实的缺血型视网膜中央静脉阻塞患者,随机分组,A组30例(30只眼)用药物治疗;B组30例(30只眼)除用药物治疗外,还用氪黄激光进行广泛视网膜光凝(激光波长568nm,功率100～300mw,光斑直径300～500μm,曝光时间0.1s,光凝872-1207点,光斑反应Ⅲ级).随访时间为治疗后1个月、3个月、半年、1年、2年和3年.结果 A组失访7例,B组失访9例;A组23例(23只眼)治疗前平均视力为0.097±0.038,治疗后平均视力为0.102±0.066,两者比较无显著差异(t=0.901,P>0.05);B组21例(21只眼)治疗前平均视力为0.094±0.034,治疗后平均视力为0.10l±0.043,两者比较无显著差异(t=0.887,P>0.05);A组和B组的治疗前平均视力比较无显著筹异(t=0.672.P>0.05);A组和B组的治疗后平均视力比较也无显著筹异(t=0.488,P>0.05);A组发生新生血管性青光眼7例.占30.4%,B组发生新牛血管性青光眼1例,占4.8%,两组比较有显著差异(x2=4.864,P<0.05).结论 氪黄激光广泛视网膜光凝能有效预防缺血型视网膜中央静脉阻塞新生血管性青光眼的发生,但不能提高视力.     

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     

A prospective study of xenon arc photocoagulation for central retinal vein occlusion.

Twenty patients with central retinal vein occlusion were randomly divided into two groups in a prospective study to evaluate the effects of xenon are photocoagulation in central retinal vein occlusion. The patients in one group were treated with 360 degrees scatter xenon photocoagulation and the others received no treatment. The average follow-up was 18 months. There were no cases of rubeosis or neovascular glaucoma in the treated group. Two patients in the untreated group developed rubeosis with subsequent neovascular glaucoma. There was no significant difference in the visual prognosis or in fundus neovascularization between the groups.     

Intravitreal bevacizumab for neovascular glaucoma following central retinal artery occlusion

PURPOSE: To report a case of neovascular glaucoma due to central retinal artery occlusion treated with a single intravitreal injection of bevacizumab. METHODS: A 68-year-old patient with a 10-week history of central retinal artery occlusion presented with neovascularization of the iris and the angle and intraocular pressure of 30 mm Hg. The patient received a single injection of 1.25 mg bevacizumab in 0.1 mL intravitreally. RESULTS: Iris and angle neovascularization regressed within 48 hours of the injection. Intraocular pressure dropped from 30 to 15 mm Hg, and there was marked improvement in patient comfort. Panretinal photocoagulation was applied 4 weeks after the injection. CONCLUSIONS: Bevacizumab seems to be a useful adjunct to panretinal photocoagulation in the treatment of neovascular glaucoma.     

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。     

Intractable glaucoma following intravitreal triamcinolone in central retinal vein occlusion

PURPOSE: To document secondary glaucoma observed after intravitreal injection of triamcinolone for cystoid macular edema in central retinal vein occlusion. DESIGN: An interventional case series. METHODS: Retrospective study. The setting was a tertiary care referral institute. Nine patients with central retinal vein occlusion and cystoid macular edema received 4.0 mg/0.1 ml of intravitreal triamcinolone acetate injected through the inferior pars plana under topical anesthesia. Baseline intraocular pressures were normal in all, and no patients had glaucoma. RESULTS: Seven of the nine patients had a post-injection rise in intraocular pressures, of which one had intractable secondary glaucoma requiring removal of the depot corticosteroid by pars plana vitrectomy combined with trabeculectomy. Two patients were controlled only by maximal medical therapy. CONCLUSIONS: The occurrence of intractable glaucoma after intravitreal triamcinolone in central retinal vein occlusion is a serious concern and warrants caution in the use of this modality for these patients.     

Bevacizumab in conjunction with panretinal photocoagulation for neovascular glaucoma

BackgroundNeovascular glaucoma (NVG) is a type of secondary angle-closure glaucoma that can result from severe retinal ischemia, such as proliferative diabetic retinopathy. Vascular endothelial growth factor (VEGF) plays a role in ocular neovascularization, which can result in NVG. The use of bevacizumab, an anti-VEGF antibody, has been shown to lead to the rapid resolution of ocular neovascularization and may be used off-label in conjunction with panretinal photocoagulation in the treatment of neovascular glaucoma.1, 2, 3, 4Case ReportA 71-year-old man presented with neovascular glaucoma in both eyes secondary to proliferative diabetic retinopathy and was treated with both panretinal photocoagulation and an intravitreal injection of bevacizumab, which led to the rapid resolution of his iris neovascularization. A follow-up examination after 12 months showed that there was no recurrence of neovascularization.ConclusionThis case shows the possible beneficial effects of bevacizumab in conjunction with panretinal photocoagulation as a treatment option for neovascular glaucoma.     

Combination intravitreal bevacizumab/panretinal photocoagulation versus panretinal photocoagulation alone in the treatment of neovascular glaucoma

PURPOSE: To evaluate same-day combination intravitreal bevacizumab/panretinal photocoagulation (PRP) for the treatment of neovascular glaucoma (NVG) compared with PRP alone. METHODS: This was an institutional review board-approved, retrospective, consecutive case-control study of patients receiving same-day combination bevacizumab/PRP or PRP alone as treatment of NVG from September 2004 through June 2007. Visual acuity, intraocular pressure (IOP), presence of anterior segment neovascularization, and required glaucoma interventional procedures were recorded. RESULTS: A total of 23 patients were identified, 11 in the bevacizumab/PRP group and 12 in the PRP alone group. The bevacizumab/PRP group had a significant reduction in IOP compared with the PRP alone group (-11 vs. 0 mmHg, respectively; P = 0.03). There was a significantly higher frequency and rate of neovascular regression in the combination therapy group than in the PRP only group (11 vs 2 eyes [P < 0.001] and 12 vs 127 days [P < 0.0001], respectively). Average follow-up was 143 days for the bevacizumab/PRP group and 118 days for the PRP alone group. CONCLUSIONS: Combination treatment resulted in more rapid decrease in IOP. In addition, the combination group had increased frequency and rapidity of regression of neovascularization. This study provides a foundation for further research and suggests consideration for a possible new paradigm for the treatment of NVG.     

康柏西普联合全视网膜激光光凝治疗缺血型视网膜中央静脉阻塞的疗效

目的:探讨康柏西普联合全视网膜激光光凝治疗缺血型视网膜中央静脉阻塞的临床疗效。方法:选取2017-01/2019-01在我院诊治的缺血型视网膜中央静脉阻塞患者80例80眼进行回顾性研究。根据治疗方式分为两组,A组40例40眼采用玻璃体腔注射康柏西普3+PRN治疗联合全视网膜激光光凝治疗;B组40例40眼采用玻璃体腔注射康柏西普3+PRN治疗。分别记录治疗前及治疗后3、6、12mo患者的最佳矫正视力(BCVA)和黄斑中心凹视网膜厚度(CMT),观察药物注射次数及不良反应。结果:治疗后12mo与治疗前比较,A组BCVA由1.05±0.58改善至0.41±0.37(P<0.01),B组由0.98±0.51改善至0.63±0.53(P<0.01),两组间比较无差异(P>0.05);A组CMT由592.30±79.75μm下降至260.08±86.23μm(P<0.01),B组CMT由604.98±81.73μm下降至406.83±162.97μm(P<0.01),且两组间比较有差异(P<0.01)。A组康柏西普注射3.15±0.43次,B组3.83±1.06次,两组间比较有差异(P<0.01)。随访期间,A组患者均未出现不良反应,B组继发新生血管性青光眼2例2眼。结论:康柏西普治疗缺血型视网膜中央静脉阻塞安全有效,联合全视网膜激光光凝可以显著改善视力,黄斑水肿消退效果更佳更稳定,降低复发率,减少并发症。     

全视网膜光凝全视网膜冷凝联合小梁切除术治疗新生血管性青光眼

目的:探讨全视网膜光凝全视网膜冷凝联合小梁切除治疗新生血管性青光眼的疗效。方法:2005-01/2006-12间对36例新生血管性青光眼患者36眼分别多次行视网膜光凝,部分患者由于屈光间质混浊不能行视网膜光凝,即行全视网膜冷凝,1wk后行小梁切除术。结果:术后所有患者随访6~12mo,30眼眼压控制正常,成功率达83%,虹膜新生血管完全消退,达100%。结论:全视网膜光凝全视网膜冷凝联合小梁切除治疗新生血管性青光眼是一种简单可靠的方法。     

Comparative evaluation of radial optic neurotomy and panretinal photocoagulation in the management of central retinal vein occlusion

PURPOSE: There is currently no treatment proven effective for central retinal vein occlusion (CRVO). Radial optic neurotomy (RON) has recently surfaced as a new treatment for the disorder, however, and we compare here the visual acuity (VA) and arteriovenous transit time (AVTT) following RON and panretinal photocoagulation (PRP). METHODS: We conducted a retrospective, uncontrolled study of 27 patients. Of 27 eyes diagnosed with CRVO, 16 were treated with panretinal photocoagulation (PRP) and 11 with RON. VA and fluorescein angiography were used to monitor the evolution of CRVO, and for follow-up. RESULTS: All patients underwent PRP or RON with no major complications. The difference between pre- and post-operative VA was not statistically significant for either group (p=0.092 on PRP; p=.0081 on RON). The change in AVTT was also not statistically significant for either group (p= 0.024 on PRP; p=0.027 on RON). Ultimately, we found no statistically-significant difference in comparing VA and AVTT for the two groups (p =0.074 on VA; p=0.510 on AVTT). CONCLUSIONS: No evidence supporting the effectiveness of RON could be found in this study, suggesting that surgical decompression by RON may not be effective for treating CRVO. Further studies regarding the efficacy of RON should be made.     

A randomised prospective study on treatment of central retinal vein occlusion by isovolaemic haemodilution and photocoagulation.

Thirty eight patients with ischaemic and non-ischaemic central retinal vein occlusion were evaluated for the effect of isovolaemic haemodilution. They were allocated at random to a haemodilution group (19 patients, panretinal photocoagulation and isovolaemic haemodilution) and a control group (19 patients, panretinal photocoagulation). Haematocrit was lowered in steps to 30 to 35% in the haemodilution group by repeated exchanges of whole blood for plasma and dextran (MW 40 000) and kept at this level for a period of six weeks. The haemodilution did not lead to serious complications. Three months after starting the treatment eight of 19 patients with haemodilution showed a better visual acuity, whereas only one of 19 control patients had improved. Seven of 17 patients with haemodilution, but only one of 17 control patients, retained a better visual acuity after one year. In the haemodilution group there were fewer patients with macular fibrosis and more with only minor foveal changes. The haemodilution seems to be more effective in patients with ischaemic than with non-ischaemic central retinal vein occlusion. It is concluded that isovolaemic haemodilution improves the visual outcome of patients with central retinal vein occlusion, probably mediated by enhanced retinal blood flow.