Talat Lazha, Lightman Sue, Tomkins-Netzer Oren
Moorfields Eye Hospital, City Road, London EC1V 2PD, UK ; UCL Institute of Ophthalmology, London EC1V 9EL, UK.
J Ophthalmol. 2014;2014:197675. doi: 10.1155/2014/197675. Epub 2014 Apr 15.
Ischemic retinal vasculitis is an inflammation of retinal blood vessels associated with vascular occlusion and subsequent retinal hypoperfusion. It can cause visual loss secondary to macular ischemia, macular edema, and neovascularization leading to vitreous hemorrhage, fibrovascular proliferation, and tractional retinal detachment. Ischemic retinal vasculitis can be idiopathic or secondary to systemic disease such as in Behçet's disease, sarcoidosis, tuberculosis, multiple sclerosis, and systemic lupus erythematosus. Corticosteroids with or without immunosuppressive medication are the mainstay treatment in retinal vasculitis together with laser photocoagulation of retinal ischemic areas. Intravitreal injections of bevacizumab are used to treat neovascularization secondary to systemic lupus erythematosus but should be timed with retinal laser photocoagulation to prevent further progression of retinal ischemia. Antitumor necrosis factor agents have shown promising results in controlling refractory retinal vasculitis excluding multiple sclerosis. Interferon has been useful to control inflammation and induce neovascular regression in retinal vasculitis secondary to Behçet's disease and multiple sclerosis. The long term effect of these management strategies in preventing the progression of retinal ischemia and preserving vision is not well understood and needs to be further studied.
缺血性视网膜血管炎是一种与血管闭塞及随后的视网膜灌注不足相关的视网膜血管炎症。它可导致继发于黄斑缺血、黄斑水肿和新生血管形成的视力丧失，进而引起玻璃体出血、纤维血管增殖和牵拉性视网膜脱离。缺血性视网膜血管炎可为特发性，或继发于系统性疾病，如白塞病、结节病、结核病、多发性硬化症和系统性红斑狼疮。在视网膜血管炎的治疗中，使用或不使用免疫抑制药物的皮质类固醇是主要治疗方法，同时对视网膜缺血区域进行激光光凝治疗。玻璃体内注射贝伐单抗用于治疗系统性红斑狼疮继发的新生血管形成，但应与视网膜激光光凝治疗同步进行，以防止视网膜缺血进一步发展。抗肿瘤坏死因子药物在控制除多发性硬化症外的难治性视网膜血管炎方面已显示出有前景的结果。干扰素已被用于控制白塞病和多发性硬化症继发的视网膜血管炎的炎症并诱导新生血管消退。这些治疗策略在预防视网膜缺血进展和保留视力方面的长期效果尚不清楚，需要进一步研究。
