视网膜电图对视网膜血管阻塞的功能评估

目的：用视网膜电图评估视网膜血管阻塞的功能改变。方法：３０例视网膜中央静脉阻塞,１５例视网膜分支静脉阻塞,７例视网膜中央动脉阻塞和６例视网膜分支动脉阻塞按照ＩＳＣＥＶ的ＥＲＧ标准进行全视野网膜电图的检测。用Ｉ１蓝光、Ｉ１６红光和Ｉ１６白光估计暗视ＥＲＧ,用Ｉ１６红光和Ｉ８白光估计明视ＥＲＧ。记录ａ波和ｂ波的振幅和潜伏期及震荡电位。结果：视网膜血管阻塞的震荡电位异常率最高,其次为ｂ波;ＥＲＧ的异常率     

合并视网膜大血管阻塞的系统性红斑狼疮的临床观察

目的：观察系统性红斑狼疮(SLE)合并视网膜大血管阻塞的临床特点。

方法：选取2010-01/2014-01我院收治的SLE合并视网膜大血管阻塞的患者17例21眼为试验组,另选取不合并视网膜病变的SLE患者30例60眼为对照组,完善眼部和全身检查及相关化验包括各种自身免疫抗体,记录临床症状和体征。

结果：试验组13例为单眼发病,4例为双眼发病,其中视网膜中央静脉阻塞(CRVO)7眼(33%),视网膜分支静脉阻塞(BRVO)9眼(43%),视网膜中央动脉阻塞(CRAO)3眼(14%),视网膜分支动脉阻塞(BRAO)1眼(5%),CRAO合并CRVO 1眼(5%)。试验组BCVA显著差于对照组; 皮肤红斑(76%)、发热(59%)、关节炎(53%)、中枢神经系统症状(头痛及精神神经异常)(76%)、胸膜炎(41%)发生率显著高于对照组; 抗ds-DNA抗体(100%)、抗磷脂抗体(65%)阳性率显著高于对照组; 补体C3降低(82%)、血沉升高(100%)、血小板减少(65%)发生率显著高于对照组。SLEDAI评分为20.24±4.66提示疾病处于中度及重度活动期。

结论：合并视网膜大血管阻塞的SLE患者,视力受损严重,全身多系统均有不同程度受累,且均为疾病中度及重度活动期。与APA、中枢神经系统病变可能存在相关性。     

Intravitreal anti-VEGF agents, oral glucocorticoids, and laser photocoagulation combination therapy for macular edema secondary to retinal vein occlusion: preliminary report

AIM: To evaluate the efficacy and safety of combined anti-vascular endothelial growth factor (VEGF) agents, oral glucocorticoid, and laser photocoagulation therapy for macular edema (ME) secondary to retinal vein occlusion (RVO). METHODS: This study included 16 eyes of 16 patients with RVO-associated ME. Patients were initially treated with oral prednisone and an intravitreal anti-VEGF agent. Two weeks later, patients underwent standard laser photocoagulation. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and retinal vessel oxygenation were examined over 12mo. RESULTS: Patients received 1.43±0.81 anti-VEGF injections. Mean baseline and 12-month logMAR BCVA were 0.96±0.51 (20/178) and 0.31±0.88 (20/40), respectively, in eyes with central retinal vein occlusion (CRVO) (P<0.00), and 1.02±0.45 (20/209) and 0.60±0.49 (20/80), respectively, in eyes with branch retinal vein occlusion (BRVO) (P<0.00). At 12mo, CRT had significantly decreased in eyes with CRVO (P<0.00) and BRVO (P<0.00). Venous oxygen saturation had significantly increased in eyes with CRVO (P<0.00) and BRVO (P<0.00). No examined parameters were significantly different between the 2 RVO groups. No serious adverse effects occurred. CONCLUSION: Anti-VEGF, glucocorticoid, and photocoagulation combination therapy improves visual outcome, prolongs therapeutic effect, and reduces the number of intravitreal injections in eyes with RVO-associated ME.     

Genetic thrombophilia in patients with retinal vascular occlusion

Background: This study was carried out to determine the prevalence of genetic thrombophilia in patients with retinal vascular occlusion.Methods: We investigated 116 consecutive patients with central retinal vein occlusion (CRVO, n = 48), branch retinal vein occlusion (BRVO, n = 33), central retinal artery occlusion (CRAO, n = 21), branch retinal artery occlusion (BRAO, n = 14). All patients underwent comprehensive tests for coagulation disorders including determinations of protein C, protein S, lupus anticoagulants, prothrombin gene mutation (G20210A), resistance to activated protein C (APCR), and were screened for vascular disease risk factors. APC resistance was confirmed by a PCR method to detect the factor V R506Q mutation. A PCR method was also used to detect the G20210A mutation. For comparative purposes, we screened 209 consecutive patients with deep vein thrombosis (DVT) and 581 patients with coronary heart disease (control group) for APC resistance.Results: 13 (27%) of 48 patients with CRVO had the factor V R506Q mutation. The factor V R506Q mutation was detected in six (18%) of 33 patients with BRVO, but in only one patient with CRAO and in two patients with BRAO. Other thrombophilic defects were not detected. The APCR prevalence within the CRVO group was significantly increased when compared to the control group (8%). There was no significant difference in the factor V R506Q mutation prevalence between the CRVO group and the DVT group (19%).Conclusion: The factor V R506Q mutation is the most commoncause of genetic thrombophilia in patients with CRVO and has a similar prevalence as in DVT patients.     

Visual Outcome in Central Retinal and Branch Retinal Artery Occlusion

Purpose To study retrospectively the presenting visual acuity and the visual outcome in patients with central retinal artery occlusion (CRAO) and in patients with branch retinal artery occlusion (BRAO).Methods We studied the visual acuity and outcome in 23 patients (23 eyes) with CRAO and in 30 patients (30 eyes) with BRAO that met the inclusion criteria: a funduscopic appearance of retinal whitening, a delay in arterial dye filling in a fluorescein angiogram, the first examination in our hospital within 7 days of onset, and a minimum follow-up period of 90 days.Results Both presenting acuity and final acuity were far worse in patients with CRAO than in patients with BRAO. A final acuity worse than 0.1 was observed in 14 of the 23 (61%) patients with CRAO and in only 1 of the 30 (3%) patients with BRAO. Only 5 of the 23 (22%) patients with CRAO and 24 of the 30 (80%) patients with BRAO showed a final acuity of 0.5 or better.Conclusion Visual acuity in patients with CRAO is poor at presentation, and the prognosis is generally poor, with a few exceptions. In contrast, the visual acuity in patients with BRAO is far better both at presentation and at the final visit. Jpn J Ophthalmol 2004;48:490–492 © Japanese Ophthalmological Society 2004     

Pseudoexfoliation and glaucoma in eyes with retinal vein occlusion

Purpose: To evaluate pseudoexfoliation (PE) and pre-existent glaucoma in eyes with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Methods: Consecutive eyes with a diagnosis of BRVO (73 eyes of 70 patients) and CRVO (53 eyes of 49 patients) examined between July and December 1998 comprised the study eyes. Age-matched control group consisted of 384 eyes of 192 outpatients. The prevalence of PE and glaucoma were determined and appropriate statistical tests were performed. Results: PE was present in six of 73 eyes with BRVO (8.2%), 11 of 53 eyes with CRVO (20.8%) and 20 of 384 control eyes (5.2%). Two of 73 eyes with BRVO (2.7%) and 10 of 53 eyes with CRVO (18.9%) had glaucoma. Compared with the control eyes, PE was significantly more common in eyes with CRVO and coexistent glaucoma was significantly more common both in eyes with CRVO and in eyes with BRVO. Conclusion: While glaucoma seems to be a risk factor both for BRVO and CRVO, PE is a likely risk factor for CRVO.     

Collateral Vessel Development in Central and Branch Retinal Vein Occlusions Are Associated With Worse Visual and Anatomic Outcomes

PurposeThe purpose of this study was to investigate the effects of the extension of collateral vessels on the outcomes of eyes affected by central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO).MethodsThe study was designed as a cross-sectional case series. Patients affected by CRVO and BRVO were progressively recruited, along with an age- and sex-matched control group of healthy subjects. Structural optical coherence tomography (OCT) and OCT angiography (OCTA; 4.5 × 4.5 mm and 9.0 × 9.0 mm acquisitions) were performed on all participants in order to assess the relationship between the presence of collateral vessels and final anatomical outcomes – central macular thickness (CMT), foveal avascular zone – and functional outcomes – best corrected visual acuity (BCVA).ResultsFifty-six eyes affected by CRVO and 47 eyes affected by BRVO were included. Baseline LogMAR BCVA was 0.41 ± 0.33 LogMAR in CRVO, and 0.39 ± 0.25 LogMAR in BRVO (P < 0.01), improving to 0.20 ± 0.26 LogMAR in CRVO (P < 0.01), and 0.19 ± 0.22 LogMAR in BRVO (P < 0.01). Baseline CMT was 511 ± 214 µm in CRVO and 482 ± 178 µm in BRVO (P > 0.05), decreasing to 328 ± 105 µm (P < 0.01) and 321 ± 78 µm in CRVO and BRVO, respectively (P < 0.01). Collateral vessels were detected in 16 of 56 eyes (29%) in CRVO and in 47 of 47 eyes (100%) in BRVO. Their extension was correlated with worse anatomic and visual outcomes. Remarkably, no correlation was found with peripheral capillary nonperfusion and vessel density impairment.ConclusionsThe present study demonstrates that collateral vessel extension is associated with worse anatomic and functional outcomes in patients affected by CRVO and BRVO.     

Electroretinograms and level of aqueous vascular endothelial growth factor in eyes with hemicentral retinal vein occlusion or branch retinal vein occlusion

Purpose

Hemicentral retinal vein occlusion (hCRVO) is a disease related to CRVO but not to branch retinal vein occlusion (BRVO). We reported a significant correlation between aqueous vascular endothelial growth factor (VEGF) levels and the implicit time of 30-Hz flicker electroretinogram (ERG) in CRVO eyes. The purpose of this study was to compare aqueous VEGF levels and ERG components between hCRVO and BRVO eyes.

Methods

The medical records of patients with macular edema secondary to hCRVO (12 eyes) or BRVO (16 eyes) and received an intravitreal injection of bevacizumab (IVB) at the Nagoya University Hospital from July 2009 to May 2013 were reviewed. Full-field ERGs were recorded before the IVB. Aqueous humor was collected just before the IVB to measure VEGF concentration. Differences in aqueous VEGF level and ERG components between hCRVO and BRVO eyes were determined.

Results

Mean aqueous VEGF concentration in hCRVO eyes was significantly higher than that in BRVO eyes (504 vs. 148 pg/ml, P < 0.05). The implicit time of 30-Hz flicker ERG was significantly longer in hCRVO than in BRVO eyes (33.5 vs. 29.8 ms, P < 0.01).

Conclusion

The significant difference in VEGF levels in aqueous and implicit times of 30-Hz flicker ERG suggest that retinal ischemia is more manifest in hCRVO than in BRVO eyes.     

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6‐month follow‐up – The SOLO study

Purpose:  To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. Methods:  The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24‐week period. Slit‐lamp biomicroscopy, measurement of best‐corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral‐domain optical coherence tomography (SD‐OCT) were performed at baseline and at every follow‐up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti‐VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. Results:  In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow‐up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow‐up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow‐up visit. Conclusions:  Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.     

Clinical,anatomical, and electrophysiological assessments of the central retina following intravitreal bevacizumab for macular edema secondary to retinal vein occlusion

The purpose of this study is to evaluate the long-term visual, anatomical and electrophysiological outcomes of repeated intravitreal injections of bevacizumab for macular edema due to retinal vein occlusion (RVO) and investigate any possible toxic effects on the central fovea. This is a prospective, noncomparative, interventional case series. Thirty-three eyes of 33 patients with macular edema secondary to RVO were treated with 1.25 mg/0.05 ml intravitreal bevacizumab. Nine patients had nonischemic central retinal vein occlusion (CRVO) and 24 patients had branch retinal vein occlusion (BRVO). The main outcome measures were best-corrected visual acuity, central retinal thickness (CRT), and multifocal electroretinography (mfERG) responses changes at baseline, 1 month after the third injection and at the end of the 2-year long follow-up period. Patients with CRVO had mean best-corrected Snellen visual acuity of 0.10 at baseline, which improved significantly to 0.31 after 2 years (P = 0. 028).The mean CRT at presentation was 756.28 μm and reduced significantly to 439.14 μm after 2 years (P = 0.05). Patients with BRVO had mean best-corrected Snellen visual acuity of 0.19 at baseline, which improved significantly to 0.40 after 2 years (P < 0.001). The mean CRT at presentation was 681.04 μm and reduced significantly to 369.81 μm after 2 years (P < 0.001). Mean mfERG responses within central 10° (ring1, ring2) showed statistically significant differences on P1 parameters in terms of response density and implicit time after 2 years in both CRVO and BRVO patients. Repeated intravitreal bevacizumab injections for macular edema due to either CRVO or BRVO resulted in long-term improvement of visual acuity, a reduction in CRT and statistically significant changes in the mfERG responses with nondemonstrable toxic effects on the central fovea.     

Retrospektive Fallanalyse zum ophthalmologischen und internistischen Risikoprofil von retinalen Gefäßverschlüssen

Objective

The aim was to determine systemic risk factors for acute central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) and to evaluate the usefulness of systemic diagnostics in CRAO and CRVO.

Methods

The study consisted of a retrospective chart review including 80 patients (CRAO 38, CRVO 42). All patients underwent systemic diagnostics including blood pressure measurement, blood cholesterol level, carotid Doppler imaging, transthoracic echocardiography (TTE), intraocular pressure measurement, glaucoma history and presence of thrombophilic factors. A systemic medical history was obtained.

Results

Systemic hypertension was found in 76.3% CRAO and 75.6% CRVO patients. Abnormal cardiac findings were detected in 61% (CRAO) and 22% (CRVO). Abnormal carotid findings were detected in 44.1% for CRAO and 9.5% for CRVO. Pathological thrombophilic factors were found in boths groups for approximately 15%.

Conclusions

TTE and carotid Doppler are important tools in the diagnosis of sources of emboli in patients with CRAO, while for CRVO abnormal findings are revealed by TTE and carotid Doppler less often. Thrombophilia should be ruled out in the absence of common risk factors, especially in younger patients and systemic hypertension should be adequately controlled.     

视网膜静脉阻塞继发黄斑水肿患者黄斑中心凹下脉络膜厚度变化研究

目的　研究视网膜中央静脉阻塞（central retinal vein occlusion,CRVO）和视网膜分支静脉阻塞（branch retinal vein occlusion,BRVO）继发黄斑水肿(ME)患者黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)的变化情况,并探讨单次玻璃体内注射康柏西普后的短期反应。方法　回顾性病例对照研究。选取2019年6月至2020年6月在我院接受治疗的31例视网膜静脉阻塞继发ME的初治患者,根据发病类型分为CRVO组（16例16眼）和BRVO组（15例15眼）。所有患者在确诊后均接受玻璃体内注射康柏西普治疗。分别在康柏西普注射前和注射后2周测量两组SFCT并比较。结果　CRVO组注射前患眼的SFCT为（319.73±19.28）μm,较对侧健眼［（255.13±16.15）μm］明显增厚,差异有统计学意义(P=0.000);注射后2周患眼的SFCT迅速降为（283.33±21.61）μm,与注射前相比差异具有统计学意义(P=0.000)。BRVO组注射前患眼SFCT为（310.31±19.41）μm,较对侧健眼［（255.31±21.69）μm］明显增厚;注射后2周患眼的SFCT迅速下降为（266.56±16.30）μm,与注射前相比差异具有统计学意义(P=0.000)。康柏西普注射前后CRVO组患眼和BRVO组患眼之间的SFCT变化值差异无统计学意义(P=0.210)。结论　CRVO和BRVO继发ME患眼的SFCT均明显比对侧健眼增厚,并在玻璃体内注射康柏西普后短时间内明显变薄。     

视网膜静脉阻塞患者视力预后相关因素分析

目的研究各型视网膜静脉阻塞患者的视力预后、并发症及视力降低的相关因素.方法视网膜静脉阻塞患者913例(944只眼),年龄15～89岁,平均(52.8±11.9)岁;平均随访时间20.7个月.患者所有临床资料均输入计算机,应用SPSS软件进行统计学处理.结果 (1)按部位分型总干阻塞406只眼,占43.0%;半侧阻塞60只眼,占6.4%;分支阻塞478只眼,占50.6%.(2)按缺血分型944只眼中,缺血型633只眼,占67.1%;非缺血型311只眼,占32.9%.(3)患者视力预后各型静脉阻塞患者治疗前、后视力比较,总干阻塞和半侧阻塞的差异无显著性(t=1.45,1.62;均P>0.05),分支阻塞的差异有显著意义(t=7.89,P<0.05).(4) 患者初诊视力水平与预后3种类型静脉阻塞患者视力预后均差;患者的初诊视力水平均与视力预后密切相关(χ2=175.261,21.357,106.408;均P<0.01).(5) 静脉阻塞导致的低视力和盲目率各型静脉阻塞患者的低视力与盲目率比较,差异有显著意义(χ2=85.251,P<0.01).(6) 缺血型与非缺血型患者视力预后比较视网膜静脉总干阻塞、半侧阻塞、分支阻塞患者中缺血型与非缺血型比较,差异均有显著意义(χ2=157.819,19.637,56.737;P<0.01).(7)导致静脉阻塞的危险因素高血压占57.8%,动脉硬化占67.4%,血液黏稠度增高占24.6%,原发性青光眼占1.5%,糖尿病占6.2%.(8) 静脉阻塞患者并发症的发生率黄斑囊样水肿占46.7%,视网膜和(或)视乳头新生血管占21.5%,玻璃体出血占11.4%,新生血管性青光眼占4.2%.其中总干阻塞发生新生血管性青光眼39只眼,占总干阻塞的9.6%,占半侧阻塞的1.7%.(9)并发症导致的低视力和盲目率低视力者中,黄斑囊样水肿占37.9%,新生血管占29.9%;盲目者中,黄斑囊样水肿占19.5%,新生血管占23.0%.新生血管性青光眼导致的盲目者中,视力<0.05者占95.0%.结论视网膜静脉阻塞的致盲率较高,影响视力预后的最重要因素是缺血型视网膜静脉阻塞.初诊视力水平与视力预后关系密切,黄斑囊样水肿、新生血管及新生血管性青光眼为致盲的重要原因.     

Retinal vessel responses to systemic autonomic stimulation in fellow eyes of patients with retinal vein occlusion

The retinal vessel calibre responses to systemic autonomic stimulation were studied in fellow eyes of 11 patients with central retinal vein occlusion (CRVO) and 10 patients with branch retinal vein occlusion (BRVO), using sustained isometric muscle contraction as the stimulus. These vessel responses were compared to those of a control group of 11 subjects of similar ages. The changes in retinal vessel calibre were measured using the Quantimet Image Analyser. There was no significant difference in mean arteriolar constriction during isometric muscle contraction (mean ± SEM) between the CRVO group (6.0 ± 1.34%) and the BRVO group (5.4 ± 0.31%), (p > 0.05), and between either of these groups compared with the control group (7.4 ± 1.20%), (p > 0.50). Similarly there was no significant difference in mean venule responses between the groups (CRVO 4.9 ± 0.48%; BRVO 4.6 ± 0.63%; control subjects 3.8 ± 0.90%;p > 0.05). The diastolic blood pressure responses were similarly not significantly different between the 3 groups (CRVO 22.3 ± 1.27, range +17 to 29mmHg; BRVO 25.8 ± 2.9mmHg, range 18 to 45mmHg; control subjects 21.3 ± 1.7mmHg, range 16 to 35mmHg), (p > 0.10). The implications of the results are discussed.     

Long-term follow-up of OCT-guided bevacizumab treatment of macular edema due to retinal vein occlusion

Background

To evaluate the long-term outcome of an OCT-guided reinjection scheme for bevacizumab treatment of macular edema (ME) due to retinal vein occlusion.

Methods

Patients with persistent ME (>250 μm) due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) received intravitreal bevacizumab 2.5 mg/0.1 ml. Visual acuity (ETDRS), ophthalmic examination and OCT were performed at baseline and at 6- to 8-week intervals. Reinjections were only performed if OCT showed persistent or recurrent ME.

Results

Sixty-one patients with a minimum follow-up of 25 weeks were included in this analysis. Mean follow-up was 60?±?29 wks. In CRVO patients, central retinal thickness (CRT) decreased from 748?±?265 µm to 372?±?224 µm (p?<?0.001) and visual acuity (VA) improved by 1.9?±?3.2 lines. In BRVO patients, mean CRT decreased from 601?±?206 µm to 386?±?178 µm (p?<?0.001) and VA improved by 1.8?±?2.6 lines. Thirty-three percent of CRVO and 15% of BRVO patients did not show a ME recurrence for ≥25 wks at last visit. Thirty-seven percent of CRVO and 50% of BRVO patients suffered recurrences of ME within the last 25 wks, whereas 30% of CRVO and 35% of BRVO patients did not achieve a complete resolution of ME at any follow-up visit after receiving a minimum of three injections. CRVO patients with dry interval of ≥25 weeks at last visit were significantly younger, had a thinner CRT at baseline and more often had a complete resolution of ME after the first injection. In CRVO and BRVO, final VA was correlated significantly with initial VA, patients’ age and final CRT. Change of VA was correlated with change of CRT in BRVO.

Conclusions

Patients with retinal vein occlusion benefit from treatment with bevacizumab. Favourable long-term results without necessity of further injections were achieved in 33% and 15% of CRVO and BRVO patients respectively. The remaining patients needed repeated injections to treat ME recurrences. However, one third of the CRVO/BRVO patients did not improve in VA, and further injections might be discontinued in these patients.     

量化OCTA在视网膜静脉阻塞中的应用

目的:应用光学相干断层扫描血管成像技术(OCTA)测量视网膜静脉阻塞(RVO)患者黄斑区血流密度、黄斑中心凹无血管区(FAZ)面积和黄斑中心凹视网膜厚度。方法:选取RVO患者30例30眼,视网膜中央静脉阻塞(CRVO)和视网膜分支静脉阻塞(BRVO)患者各15例,双眼接受OCTA检查,获取黄斑中心3mm×3mm大小范围的血流密度、FAZ面积、黄斑中心凹视网膜厚度,以及双眼最佳矫正视力(BCVA)。比较患眼与健眼上述指标的变化及其与BCVA的相关性。结果:CRVO患者患眼黄斑区视网膜浅层毛细血管网(SVN)、深层毛细血管网(DVN)总血流密度较健眼降低[SVN:(43.07±4.95)%vs(50.09±2.86)%,DVN:(45.89±4.12)%vs(53.29±2.62)%,均P<0.01],与BCVA呈负相关(r_s=-0.6、-0.5,均P<0.05)。BRVO患者患眼SVN、DVN总血流密度较健眼降低[SVN:(45.62±3.04)%vs(52.10±2.98%),DVN:(49.21±3.80)%vs(55.52±3.33%),均P<0.01],与BCVA呈负相关(r_s=-0.5、-0.5,均P<0.05)。BRVO患眼病变区域与患眼未病变区域、健眼对应区域比较,SVN、DVN血流密度均下降(均P<0.01);患眼未病变区域DVN血流密度较健眼相应区域下降[(56.86±1.95)%vs(58.15±2.24)%,P=0.02];患眼病变区域DVN血流密度与BCVA呈负相关(r_s=-0.6,P=0.01)。CRVO、BRVO患眼SVN的FAZ面积较健眼明显扩大(CRVO:0.515±0.26mm²vs 0.27±0.08mm²,P<0.01;BRVO:0.376±0.12mm²vs 0.261±0.07mm²,P<0.01),且均与BCVA呈正相关(CRVO:r_s=0.6,P=0.01;BRVO:r_s=0.5,P=0.01)。CRVO、BRVO患眼黄斑中心凹视网膜厚度均较健眼增加(CRVO:431.2±191.3μm vs 235.5±18.2μm,P<0.01;BRVO:373.2±188.7μm vs 233.8±13.7μm,P=0.01),均与BCVA呈正相关(CRVO:r_s=0.9,P=0.01;BRVO:r_s=0.6,P=0.01)。结论:OCTA可作为测量RVO患者黄斑区血流密度、FAZ面积及黄斑中心凹视网膜厚度的有效工具。     

Study of clinical applications and safety for Pascal® laser photocoagulation in retinal vascular disorders

Purpose: To establish safe laser parameter standards for 10–30 ms Pascal^® laser in clinical practice and to evaluate clinical and visual outcomes using this 532‐nm multi‐spot photocoagulation system. Methods: Retrospective observational case series of 313 patients treated between 2006 and 2008. Evaluation of eight groups: A – panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR); B – focal laser treatment for clinically significant diabetic macular oedema; C – grid laser for diffuse diabetic macular oedema; D – sector PRP for ischaemic branch retinal vein occlusions (I‐BRVO); E – full PRP for ischaemic central retinal vein occlusions (I‐CRVO); F – macular laser treatment for macular oedema secondary to non‐ischaemic BRVO; G – full PRP for rubeosis iridis and/or neovascular glaucoma (NVG) secondary to I‐BRVO, I – CRVO or PDR; H – laser retinopexy for retinal breaks/degenerations. Results: Mean LogMAR visual acuity for all procedures improved postlaser (p = 0.065), and laser prevented visual loss in 85% eyes. Topical anaesthesia was only required. At mean follow‐up of 5 months, 72% procedures had a successful clinical outcome. Significantly higher powers were required for PRP using Pascal^® compared to conventional laser (p = 0.001) in PDR, I‐BRVO, I‐CRVO and NVG. Sixty‐seven per cent of patients (15/20) were successfully treated with single‐session 20‐ms PRP using a mean 1952 burns. There were no laser‐associated adverse effects or ocular complications associated with multi‐spot PRP or macular Pascal^® arrays. Conclusions: The clinical efficacy using 10‐ to 30‐ms pulse duration Pascal^® laser is comparable to conventional standard protocols used for the treatment of vascular retinal disorders. Higher power, 10‐ to 30‐ms pulse duration laser may be safely and effectively used in clinical practice.     

康柏西普联合激光治疗缺血型视网膜静脉阻塞继发黄斑水肿

目的:观察玻璃体腔注射康柏西普联合周边视网膜激光治疗缺血型视网膜静脉阻塞继发黄斑水肿(RVO-ME)的疗效。方法:回顾性病例研究。收集2014-10/2018-11在温州医科大学附属眼视光医院诊断为缺血型RVO-ME的患者39例39眼,其中CRVO患者14例14眼,BRVO患者25例25眼。所有患者均予玻璃体腔注射康柏西普联合周边视网膜激光光凝治疗。分别于治疗前后检测最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT)。结果:治疗后1、2、3、6mo,本组患者BCVA(0.67±0.49、0.56±0.41、0.62±0.52、0.47±0.40)均较治疗前(0.99±0.57)显著改善(P <0.05),CMT (299.5±188.1、254.8±127.6、294.1±174.9、228.8±64.45μm)均较治疗前(608.4±214.7μm)显著下降(P<0.05)。治疗后6mo BCVA与治疗前基线BCVA呈正相关(r=0.78,P<0.05),而与治疗前CMT无明显相关性(r=0.25,P=0.13)。结论:玻璃体腔注射康柏西普联合周边视网膜激光光凝治疗缺血型RVO-ME疗效确切,可有效改善视力,降低CMT。     

The role of axial length in central and branch retinal vein occlusion

BACKGROUND AND OBJECTIVE: To assess whether the axial length is a local risk factor in central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: The axial lengths of affected and fellow eyes of 19 patients with CRVO and 27 with BRVO and of their controls were measured with A-scan ultrasonography. The control group consisted of 17 individuals for CRVO and 25 for BRVO matched in age, sex and the prevalence of hypertension and diabetes in patient groups. The results of measurements in affected, unaffected and control eyes were compared. RESULTS: The mean axial length was different among the affected and unaffected eyes in patients with CRVO and their controls (P < .05). The affected eyes had significantly shorter axial length compared to the fellow and control eyes (P < .01 and P < .01, respectively). In the BRVO group, the mean axial length did not differ among affected, unaffected and control eyes (P > .05). CONCLUSIONS: Our study demonstrates a significantly shorter axial length in eyes with CRVO and not significantly shorter axial length in those with BRVO. The shorter axial length could be an additional risk factor in the pathogenesis of CRVO.     

真实世界下玻璃体腔内注射抗VEGF药物治疗眼底疾病的实效性研究

目的:研究真实世界下玻璃体腔内注射抗VEGF药物治疗眼底疾病的疗效.方法:选择2012-09/2015-08在我科应用抗VEGF药物的临床病例,回顾性调查抗VEGF药物应用的病种、频次、用法、疗效、不良反应,以及其对视力、眼底情况及黄斑中心凹厚度等指标的影响.结果:选取接受抗VEGF药物玻璃体腔内注射治疗的患者305例340眼,其中53例60眼(17.6%)为湿性年龄相关性黄斑变性(AMD)、16例18眼(5.3%)息肉样脉络膜血管病变(PCV)、120例134眼(39.4%)为糖尿病性黄斑水肿(DME)、61例68眼(20.0%)为视网膜分支静脉阻塞(BRVO)合并黄斑水肿、29例32眼(9.4%)为视网膜中央静脉阻塞(CRVO)合并黄斑水肿、16例18眼(5.3%)特发性脉络膜新生血管、4例4眼(1.2%)高度近视伴发脉络膜新生血管、4例4眼(1.2%)新生血管性青光眼、1例1眼(0.2%)视网膜血管瘤样增生(RAP)和视乳头新生血管1例1眼(0.2%).年龄为16～90岁.247例275眼(80.9%)使用雷珠单抗注射液,58例65眼(19.1%)使用康柏西普注射液.所有患者共计接受抗VEGF药物治疗次数为565次,平均为1.7次/眼.其中,采用"3+按需治疗(PRN)"治疗方法的有98例109眼(32.1%),"1+PRN"治疗方法的有207例231眼(67.9%).单独使用抗VEGF药物69例77眼(22.6%),联合曲安奈德玻璃体腔注射10例11眼(3.2%),联合玻璃体切割手术35例39眼(11.5%),联合PDT治疗26例29眼(8.5%),联合单纯眼底激光治疗例165例184眼(54.1%).经抗VEGF药物治疗后,绝大多数的最矫正视力(BCVA)、眼底情况和黄斑中心凹厚度(CMT)均有明显改善,与术前相比较,差异有统计学意义(P<0.05).表明抗VEGF药物可以有效地改善眼底疾病的视功能和眼底情况.本组病例在应用抗VEGF药物治疗期间,除有3例出现皮肤发红、瘙痒、皮疹,1例出现低热和1例出急性脑梗塞等不良事件外,其余均未发生其他严重不良反应.结论:玻璃体腔内注射抗VEGF药物能明显改善眼底疾病的视功能和眼底情况,但临床尚存在一些不良事件的发生,需引起医务工作者的高度重视.