Williamson T H, Poon W, Whitefield L, Strothidis N, Jaycock P
Department of Ophthalmology, St Thomas's Hospital, London SE1 7EH, UK.
Br J Ophthalmol. 2003 Sep;87(9):1126-9. doi: 10.1136/bjo.87.9.1126.
BACKGROUND/AIMS: There is no effective treatment for ischaemic central retinal vein occlusion (CRVO). The two major negative outcomes are neovascular glaucoma (NVG) and severe central visual loss. In this study pars plana vitrectomy (PPV), mild panretinal photocoagulation, and intraocular gas injection were employed to prevent NVG. The potential role of incision of the lamina cribrosa (radial neurotomy) for visual recovery was examined.
Eight eyes of seven patients with ischaemic CRVO had PPV, mild panretinal photocoagulation, and intraocular perfluoropropane gas injection. Four eyes had radial neurotomies performed. The patients were examined by fundus photography, fundus fluorescein angiography, optical coherence tomography, and Goldmann visual field analysis.
No patients suffered from neovascular glaucoma. Visual recovery was seen in patients with and without neurotomy but some patients had cataract extraction to allow visualisation for PPV. Fundus photography demonstrated reduced engorgement of retinal veins in two of the patients with neurotomy and one with PPV alone. Optical coherence tomography demonstrated macular oedema in three patients with neurotomy and all patients with PPV alone. Segmental visual field loss was seen in one patient with neurotomy suggesting damage to the optic nerve head.
PPV is safe in ischaemic CRVO. Combined with mild PRP and intraocular gas injection the risk of neovascular glaucoma is low. Neurotomy can be added to try to improve the chances of recovery of central vision but may cause additional peripheral visual field loss.
背景/目的：缺血性视网膜中央静脉阻塞（CRVO）尚无有效的治疗方法。两个主要的不良后果是新生血管性青光眼（NVG）和严重的中心视力丧失。在本研究中，采用玻璃体切割术（PPV）、轻度全视网膜光凝和眼内气体注射来预防NVG。研究了切开筛板（放射状神经切开术）对视力恢复的潜在作用。
7例缺血性CRVO患者的8只眼接受了PPV、轻度全视网膜光凝和眼内注入全氟丙烷气体。4只眼进行了放射状神经切开术。通过眼底照相、眼底荧光血管造影、光学相干断层扫描和Goldmann视野分析对患者进行检查。
无患者发生新生血管性青光眼。接受和未接受神经切开术的患者均有视力恢复，但部分患者进行了白内障摘除以便进行PPV操作时观察眼底。眼底照相显示，2例接受神经切开术的患者和1例仅接受PPV的患者视网膜静脉充血减轻。光学相干断层扫描显示，3例接受神经切开术的患者和所有仅接受PPV的患者均有黄斑水肿。1例接受神经切开术的患者出现节段性视野缺损，提示视神经乳头受损。
PPV对于缺血性CRVO是安全的。联合轻度PRP和眼内气体注射，新生血管性青光眼的风险较低。可增加神经切开术以尝试提高中心视力恢复的机会，但可能会导致额外的周边视野缺损。
