Retinal Vein Occlusions
Retinal Vein Occlusions
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DOI：
10.1159/000320076
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发表时间：
2010-01-01
期刊：
影响因子：
--
通讯作者：
Glacet-Bernard, Agnes
中科院分区：
文献类型：
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作者：
Jonas, Jost;Paques, Michel;Glacet-Bernard, Agnes
视网膜静脉阻塞（RVO）已被定义为视网膜血管疾病，其特征在于视网膜静脉扩张伴视网膜和视网膜下病变和黄斑水肿和/或视网膜缺血。血管造影（FA）仍然是诊断和预后的RVO至关重要的，允许识别不同类型的RVO，如灌注或非灌注，以及检测不同的方式在自然历史。FA是确定黄斑囊样水肿的存在（或不存在）、其扩展、持续、消退或缺血程度的最有效方法。光谱域光学相干断层扫描（SD-OCT）有助于量化视网膜厚度的变化，囊样黄斑水肿的量，并提供额外的信息，例如积聚的液体是否主要位于视网膜层内或另外位于视网膜下腔。SD-OCT可以显示视网膜外界膜的存在和完整性以及视网膜光感受器的内外节段，为RVO的预后提供有用的信息并指导治疗。根据SCORE试验的最新结果，在FA显示为渗漏的区域上的“网格”图案中的激光光凝仍然是“视网膜分支静脉阻塞引起的黄斑水肿的参考治疗”。最近的病例系列研究和前瞻性随机试验强烈表明玻璃体内类固醇的抗水肿作用和视力的相关改善。这些研究表明，玻璃体内类固醇（缓释装置中的曲安西龙、氟轻松、地塞米松）和玻璃体内抗VEGF药物（贝伐单抗、雷珠单抗、培加他尼）至少可以暂时减轻黄斑水肿，并相应改善视觉功能。已报告了RVO的手术治疗方式。玻璃体切除术的积极作用似乎是持久的;手术和玻璃体内注射类固醇和/或注射组织纤溶酶原激活剂的组合可以允许更快速和持久的作用。然而，来自随机试验的强有力的数据是必要的。版权所有（C）2010 S. Karger AG，巴塞尔
Retinal vein occlusions (RVOs) have been defined as retinal vascular disorders characterized by dilatation of the retinal veins with retinal and subretinal hemorrhages and macular edema, and/or retinal ischemia. Fluorescein angiography (FA) remains essential for the diagnosis and prognosis of RVO, allowing recognition of the diverse types of RVO, such as perfused or nonperfused, as well as detection of the different modalities in natural history. FA is the most effective method to determine the presence (or absence) of macular cystoid edema, its extension, persistence, regression, or the degree of ischemia. Spectral domain optical coherence tomography (SD-OCT) helps to quantify the changes in retinal thickness, the amount of cystoid macular edema, and supplies additional information, such as whether the accumulated fluid is located mostly within the retinal layers or additionally in the subretinal space. SD-OCT can display the presence and integrity of the outer limiting membrane and of the inner and outer segments of the photoreceptors, useful information for prognosis and a guide for treatment in the management of RVO. Laser photocoagulation in a 'grid' pattern over the area, demonstrated as leaking by FA, remains the 'reference treatment for macular edema due to branch retinal vein occlusion', according to the recent results of the SCORE Trial. Recent case series studies and prospective randomized trials strongly suggest an antiedematous effect of intravitreal steroids and an associated improvement in vision. These studies have suggested that intravitreal steroids (triamcinolone, fluocinolone, dexamethasone in a slow-release device) and intravitreal anti-VEGF drugs (bevacizumab, ranibizumab, pegabtanib) may at least temporarily reduce foveal edema and correspondingly improve visual function. Surgical treatment modalities have been reported for RVOs. The positive action of vitrectomy seems durable; the combination of surgery and intravitreal injection of steroids and/or an injection of tissue plasminogen activator could permit a more rapid and lasting action. However, strong data from randomized trials are warranted. Copyright (C) 2010 S. Karger AG, Basel