A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. The Central Vein Occlusion Study Group N report.
A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. The Central Vein Occlusion Study Group N report.
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发表时间：
1995
期刊：
影响因子：
13.7
通讯作者：
J. Clarkson;E. Chuang;D. Gass;M. Pedroso;T. Cubillas;E. S. Duria;D. Hess;I. Rams;M. Ball;A. Gutierrez;N. Muniz;J. Thompson;M. Pall;C. Pappas;D. Finkelstein;A. Patz;D. Rytel;J. Belt;D. Cain
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作者：
J. Clarkson;E. Chuang;D. Gass;M. Pedroso;T. Cubillas;E. S. Duria;D. Hess;I. Rams;M. Ball;A. Gutierrez;N. Muniz;J. Thompson;M. Pall;C. Pappas;D. Finkelstein;A. Patz;D. Rytel;J. Belt;D. Cain
目的 回答缺血性中央静脉阻塞 (CVO) 中预防性全视网膜光凝 (PRP) 是否可以预防 2 小时虹膜新生血管或任何角度新生血管 (TC-INV/ANV) 的发展，或者仅在发生 TC-INV/ANV 时应用 PRP 是否更合适。方法 针对缺血性 CVO 眼的多中心随机对照临床试验。眼睛被分配到立即预防性 PRP（90 只眼）或经常密切观察（91 只眼）。如果出现 TC-INV/ANV，则未经治疗的眼睛将接受 PRP，之前治疗过的眼睛将接受补充 PRP。结果 在两组中，预防性治疗的眼睛中 TC-INV/ANV 的发生率低于未治疗的眼睛，但在调整基线不平衡后，差异不具有统计学意义。 TC-INV/ANV 治疗后，32 只眼睛中的 18 只 (56%) 先前未经治疗的眼睛和 18 只接受过预防性治疗的眼睛中的 4 只 (22%) 迅速消退（1 个月内）。除八只眼睛外，所有眼睛最终都稳定下来，没有新生血管形成。 TC-INV/ANV 与非灌注视网膜的数量（P = 0.0001）和视网膜出血的程度（P = 0.03）相关。男性发生 TC-INV/ANV 的风险高于女性（P = 0.01），闭塞时间少于 1 个月的患者也是如此（P = 0.01）。结论 预防性 PRP 并不能完全预防 TC-INV/ANV，并且在先前未接受过治疗的眼睛中，更有可能发生 PRP 引起的 TC-INV/ANV 迅速消退。作者建议在最初几个月进行仔细观察和频繁的随访检查（包括虹膜的未散瞳裂隙灯检查和房角镜检查），并对出现 TC-INV/ANV 的眼睛及时进行 PRP。
PURPOSE To answer whether prophylactic panretinal photocoagulation (PRP) in ischemic central vein occlusion (CVO) prevents development of 2 clock hours of iris neovascularization or any angle neovascularization (TC-INV/ANV) or whether it is more appropriate to apply PRP only when TC-INV/ANV occurs. METHODS Multicenter randomized controlled clinical trial in eyes with ischemic CVO. Eyes were assigned to immediate prophylactic PRP (90 eyes) or to frequent close observation (91 eyes). If TC-INV/ANV developed, untreated eyes received PRP and previously treated eyes received supplemental PRP. RESULTS In both groups, TC-INV/ANV developed less often in prophylactically treated than untreated eyes, but the difference was not statistically significant when adjusted for baseline imbalance. Treatment of TC-INV/ANV was followed by prompt regression (within 1 month) in 18 (56%) of 32 previously untreated eyes and in 4 (22%) of 18 eyes that had had prophylactic treatment. All eyes except eight eventually stabilized without neovascularization. TC-INV/ANV was correlated with the amount of nonperfused retina (P = 0.0001) and extent of retinal hemorrhage (P = 0.03). Males were at higher risk than females for TC-INV/ANV (P = 0.01), as were patients with occlusions of less than one month duration (P = 0.01). CONCLUSIONS Prophylactic PRP does not totally prevent TC-INV/ANV, and prompt regression of TC-INV/ANV in response to PRP is more likely to occur in eyes that have not been treated previously. The authors recommend careful observation with frequent follow-up examinations in the early months (including undilated slit-lamp examination of the iris and gonioscopy) and prompt PRP of eyes in which TC-INV/ANV develops.