Microaneurysms cause refractory macular edema in branch retinal vein occlusion.
Microaneurysms cause refractory macular edema in branch retinal vein occlusion.
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DOI：
10.1038/srep29445
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发表时间：
2016-07-08
影响因子：
4.6
通讯作者：
Ogura Y
中科院分区：
文献类型：
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作者：
Tomiyasu T;Hirano Y;Yoshida M;Suzuki N;Nishiyama T;Uemura A;Yasukawa T;Ogura Y
玻璃体内抗血管内皮生长因子（VEGF）药物可以治疗视网膜分支静脉闭塞（BRVO）的黄斑水肿（ME）。然而，难治性ME经常发生，其机制尚不清楚。66只眼继发于BRVO的ME纳入了这项回顾性观察性病例对照研究。20只眼接受亚tenon胶囊注射曲安奈德（STTA）， 22只眼接受玻璃体内抗vegf注射（雷尼单抗），16只眼由STTA转为雷尼单抗，4只眼行玻璃体切除术，4只眼未治疗。分别进行多元回归分析和多元logistic回归分析，以确定1年以上难治性ME患者视力（VA）预后的独立预测因素和危险因素。对难治性ME的发病机制和确定的危险因素的治疗方法也进行了研究。34只（52%）眼难治性ME持续1年以上。微动脉瘤被认为是难治性ME的危险因素，导致最终VA差。雷尼单抗抑制微动脉瘤形成和难治性ME，早期给药更有效。对于已经形成的微动脉瘤，激光光凝减少了额外的治疗。微动脉瘤可引起BRVO难治性ME。为预防BRVO患者难治性ME，应考虑抑制微动脉瘤的替代疗法。
Intravitreal anti-vascular endothelial growth factor (VEGF) agents can treat macular edema (ME) in branch retinal vein occlusion (BRVO). However, refractory ME, the mechanism of which is not well elucidated, occurs frequently. Sixty-six eyes with ME secondary to BRVO were enrolled in this retrospective observational case-control study. Twenty eyes received a sub-Tenon’s capsule injection of triamcinolone acetonide (STTA), 22 eyes an intravitreal anti-VEGF injection (ranibizumab), 16 eyes were switched from STTA to ranibizumab, 4 eyes underwent vitrectomy, and 4 eyes were untreated. Multiple regression analysis and multivariate logistic regression analysis were conducted, respectively, to identify independent predictors of visual acuity (VA) prognosis and risk factors for refractory ME longer than 1 year. The mechanism of refractory ME and therapeutic approaches for identified risk factors also were investigated. Thirty-four (52%) eyes had refractory ME for over 1 year. Microaneurysms were identified as risk factors for refractory ME, leading to poor final VA. Ranibizumab suppressed microaneurysm formation and refractory ME, with early administration more effective. For already formed microaneurysms, laser photocoagulation reduced additional treatments. Microaneurysms may cause refractory ME in BRVO. Alternative therapy to suppress microaneurysms should be considered to prevent refractory ME in patients with BRVO.