Baba A, Miri A, Guillaumie T, Zongo P D
Service d'ophtalmologie, centre hospitalier de Yves le Foll, 22000 Saint-Brieuc, France.
Service d'ophtalmologie, centre hospitalier de Yves le Foll, 22000 Saint-Brieuc, France.
J Fr Ophtalmol. 2020 Apr;43(4):305-311. doi: 10.1016/j.jfo.2019.08.014. Epub 2020 Feb 20.
The goal of our study is to highlight, through a series of 4 cases, the importance of retinal fluorescein angiography in monitoring the retinal periphery in retinal vein occlusions, particularly in cases of recurrent macular edema.
This is a series of 4 patients aged between 50 and 90 years with ischemic central retinal vein occlusions in 2 cases and branch retinal venous occlusions in 2 cases. Fluorescein angiography was performed in two of our patients, and optical coherent tomography in all cases, showing cystoid macular edema with an average macular thickness of 439μm. All patients received a complete etiological assessment and intravitreal anti-VEGF injections with an initially favorable course in all cases. A recurrence with aggravation of the edema compared to the initial appearance was observed in all cases, with a delay varying between 9 and 16 months (mean 11.25 months). Fundus examination revealed an increased number of retinal hemorrhages in each case, with the appearance of cotton wool spots in one case, suggesting ischemic conversion. This was confirmed by performing fluorescein angiography, which revealed large areas of retinal ischemia. Retinal photocogulation of the ischemic areas was thus indicated, along with a second series of intravitreal injections.
Macular edema is the principal cause of visual acuity decline in retinal vein occlusions; its prognosis is similar to that of retinal venous occlusions in general, hampered by the possibility of ischemic conversion. The diagnosis of retinal vein occlusion is clinical and does not require angiography. This remains, however, a useful exam to better analyze the retinal periphery as well as for the detection of various modalities during spontaneous progression.
我们的研究目标是通过4个病例系列，强调视网膜荧光血管造影在监测视网膜静脉阻塞时视网膜周边情况中的重要性，尤其是在复发性黄斑水肿的病例中。
这是一组4例患者，年龄在50至90岁之间，其中2例为缺血性中央视网膜静脉阻塞，2例为视网膜分支静脉阻塞。我们对2例患者进行了荧光血管造影，所有病例均进行了光学相干断层扫描，显示黄斑囊样水肿，平均黄斑厚度为439μm。所有患者均接受了全面的病因评估并进行了玻璃体内抗VEGF注射，所有病例初始病程均良好。所有病例均观察到水肿复发且较初始表现加重，延迟时间在9至16个月之间（平均11.25个月）。眼底检查发现每个病例视网膜出血数量增加，1例出现棉絮斑，提示缺血性转化。荧光血管造影证实了这一点，显示视网膜大面积缺血。因此，指示对缺血区域进行视网膜光凝，并进行第二系列玻璃体内注射。
黄斑水肿是视网膜静脉阻塞中视力下降的主要原因；其预后与一般视网膜静脉阻塞相似，因缺血性转化的可能性而受到影响。视网膜静脉阻塞的诊断是临床诊断，不需要血管造影。然而，血管造影仍是一项有用的检查，可更好地分析视网膜周边情况以及在疾病自然进展过程中检测各种变化形式。
