视网膜分支静脉阻塞和视网膜中央静脉阻塞中周边视网膜无灌注区及治疗反应

Area of peripheral retinal nonperfusion and treatment response in branch and central retinal vein occlusion.

作者信息

Singer Michael, Tan Colin S, Bell Darren, Sadda Srinivas R

机构信息

*Medical Center Ophthalmology, San Antonio, Texas; †Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore; ‡Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore, Singapore; and §Doheny Eye Institute, University of Southern California, Los Angeles, California.

出版信息

Retina. 2014 Sep;34(9):1736-42. doi: 10.1097/IAE.0000000000000148.

DOI:10.1097/IAE.0000000000000148

PMID:24732695

Abstract

PURPOSE

To evaluate the extent of peripheral retinal nonperfusion in retinal vein occlusion and to determine its effect on the severity of macular edema and response to treatment.

METHODS

This prospective clinic-based cohort study included 32 consecutive patients with retinal vein occlusion and refractory macular edema evaluated using spectral domain optical coherence tomography and wide-field fluorescein angiography. Areas of ischemia were calculated as a percentage of the total visible retina (ischemic index), which was evaluated when macular edema was present (foveal central subfield >300 μm) and when edema had resolved (foveal central subfield ≤ 300 μm). Ischemic index was the main outcome measure.

RESULTS

The mean ischemic index at study enrollment was 14.8% and was larger when macular edema was present compared with when edema had resolved (14.8 vs. 10.3%, P < 0.001). Compared with those with less nonperfusion, patients with ischemic index >10% had thicker mean foveal central subfield on optical coherence tomography (520.8 vs. 424.5 μm, P = 0.029) and worse visual acuity (56.3 vs. 59 letters) with the presence of macular edema and experienced greater decrease in optical coherence tomography (296.1 vs. 165.3 μm, P = 0.019) and gain in visual acuity (12.4 vs. 0.9 letters, P = 0.036) in response to treatment.

CONCLUSION

The area of peripheral retinal nonperfusion is variable in patients with retinal vein occlusion and affects its clinical course and response to treatment.

摘要

目的

评估视网膜静脉阻塞时周边视网膜无灌注的程度，并确定其对黄斑水肿严重程度及治疗反应的影响。

方法

这项基于临床的前瞻性队列研究纳入了32例连续的视网膜静脉阻塞和难治性黄斑水肿患者，使用频域光学相干断层扫描和广角荧光素血管造影进行评估。缺血区域计算为可见视网膜总面积的百分比（缺血指数），分别在存在黄斑水肿时（黄斑中心凹子区域>300μm）和水肿消退时（黄斑中心凹子区域≤300μm）进行评估。缺血指数是主要的观察指标。

结果

研究入组时的平均缺血指数为14.8%，存在黄斑水肿时的缺血指数大于水肿消退时（14.8%对10.3%，P<0.001）。与无灌注较少的患者相比，缺血指数>10%的患者在光学相干断层扫描上黄斑中心凹子区域平均更厚（520.8对424.5μm，P=0.029），在存在黄斑水肿时视力更差（56.3对59个字母），并且在治疗后光学相干断层扫描上的下降幅度更大（296.1对165.3μm，P=0.019），视力提高幅度更大（12.4对0.9个字母，P=0.036）。