抗VEGF时代激光视网膜光凝在视网膜静脉阻塞临床管理中的价值

视网膜静脉阻塞(retinal vein occlusion, RVO)是仅次于糖尿病视网膜病变的常见视网膜血管疾病,其视力损害的主要原因是黄斑水肿(macular edema,ME)和眼部新生血管(neovascularition,NV)并发症,尤其是新生血管性青光眼(neovascular glaucoma,NVG)。虽然激光视网膜光凝治疗ME、NV和NVG的疗效早已明确,但抗VEGF治疗可有效改善RVO患者的视力预后,已成为RVO-ME的一线治疗方法,也有助于治疗NV和NVG。近期研究表明,增加激光治疗并不能增加抗VEGF治疗RVO-ME的视力收益,也不能降低抗VEGF注射次数;抗VEGF治疗不能阻止,但可延迟缺血性RVO发生NV并发症。播散性激光视网膜光凝仍是治疗NV并发症的核心方法,但不鼓励预防性激光治疗。(眼科,2022,31:165-168)

The value of laser retinal photocoagulation in clinical management of retinal vein occlusion in era of anti-VEGF

Retinal vein occlusion (RVO) is the most common retinal vascular disease second to diabetes retinopathy. The main causes of its visual impairment are macular edema (ME) and ocular neovascularition (NV), especially neovascular glaucoma (NVG). Although the efficacy of laser retinal photocoagulation has long been determined for treatment of ME, NV and NVG, anti-vascular endothelial growth factor (VEGF) therapy can effectively improve the visual outcomes of RVO patients, and has become the first-line treatment for ME and helpful for the treatment of NV and NVG. Recent studies have shown that addition of laser cannot lead to better visual acuity or lower the number of injections in anti-VEGF treatment for RVO-ME, while intravitreal anti-VEGF therapy delayed, but could not prevent NV complication. Scatter laser photocoagulation plays a pivotal role in treatment of NV complications, but prophylactic laser treatment should not be encouraged. (Ophthalmol CHN, 2022, 31: 165-168)