视网膜分支静脉阻塞:流行病学、发病机制、危险因素、临床特征、诊断和并发症。文献更新。

Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature.

机构信息

Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.

出版信息

Retina. 2013 May;33(5):901-10. doi: 10.1097/IAE.0b013e3182870c15.

Abstract

BACKGROUND/PURPOSE: Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, the purpose is to make an update of the literature about the classification, epidemiology, pathogenesis, risk factors, clinical features, and complications of branch retinal vein occlusion (BRVO).

METHODS

Eligible articles were identified using a comprehensive literature search of MEDLINE, using the terms "branch retinal vein occlusion," "pathogenesis," "epidemiology," "risk factors," "clinical features," "diagnosis," and "complications." Additional articles were also selected from reference lists of articles identified by the electronic database search.

RESULTS

Classification, epidemiology, pathogenesis, risk factors, clinical features, and complications are analyzed.

CONCLUSIONS

Branch retinal vein occlusion has an incidence of 0.5% to 1.2%. Several risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, thrombophilia and hypercoagulation, systemic and inflammatory diseases, medications, and ocular conditions, have found to be associated with BRVO. The symptoms depended on the site and severity of the occlusion. The average reduction in visual acuity for ischemic BRVO is 20/50 and for nonischemic BRVO is 20/60. Acute BRVO can be detected by fundoscopy, where flame hemorrhages, dot and blot hemorrhages, cotton wool spots, hard exudates, retinal edema, and dilated tortuous veins can be observed. Chronic BRVO would be more subtle and characterized by the appearance of venous collateral formation and vascular sheathing, in addition to complications previously mentioned. Areas of ischemia can be evaluated using fluorescein angiography. The extent of macular edema and the presence of retinal detachment can be detected by fundoscopic examination or fluorescein angiography, although optical coherence tomography is considered to be the best method. As far as complications, the most common is macular edema, followed by retinal neovascularization, vitreous hemorrhage, or retinal detachment.

摘要

背景/目的:视网膜静脉阻塞是仅次于糖尿病性视网膜病变的第二大常见视网膜血管疾病,被认为是视力丧失的重要原因。在这篇综述中,目的是对分支视网膜静脉阻塞(BRVO)的分类、流行病学、发病机制、危险因素、临床特征和并发症的文献进行更新。

方法

通过对 MEDLINE 进行全面的文献检索,使用“分支视网膜静脉阻塞”、“发病机制”、“流行病学”、“危险因素”、“临床特征”、“诊断”和“并发症”等术语,确定符合条件的文章。还从电子数据库搜索确定的文章参考文献列表中选择了其他文章。

结果

分析了分类、流行病学、发病机制、危险因素、临床特征和并发症。

结论

分支视网膜静脉阻塞的发病率为 0.5%至 1.2%。高血压、高血脂、糖尿病、血栓形成和高凝状态、全身和炎症性疾病、药物和眼部疾病等几种危险因素已被发现与 BRVO 相关。症状取决于阻塞的部位和严重程度。缺血性 BRVO 的平均视力下降为 20/50,非缺血性 BRVO 的平均视力下降为 20/60。急性 BRVO 可通过眼底镜检查发现,可观察到火焰状出血、点状和斑片状出血、棉絮斑、硬性渗出物、视网膜水肿和扩张迂曲的静脉。慢性 BRVO 更为微妙,除了先前提到的并发症外,还表现为静脉侧支形成和血管鞘的出现。可以使用荧光素血管造影评估缺血区域。可以通过眼底检查或荧光素血管造影检测黄斑水肿程度和视网膜脱离的存在,尽管光相干断层扫描被认为是最好的方法。至于并发症,最常见的是黄斑水肿,其次是视网膜新生血管、玻璃体积血或视网膜脱离。

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