Hayreh Sohan Singh
Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA.
Prog Retin Eye Res. 2021 Nov;85:100964. doi: 10.1016/j.preteyeres.2021.100964. Epub 2021 Mar 11.
The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself. Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed. In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed. The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed. Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.
自1974年以来，人们一直在研究光凝术在视网膜静脉阻塞（RVO）中的作用。视网膜中央静脉阻塞（CRVO）和视网膜分支静脉阻塞（BRVO）最严重的并发症是：（i）视力下降，最常见的原因是黄斑水肿；（ii）眼部新生血管形成（NV），特别是新生血管性青光眼（NVG），对视功能甚至眼球本身都有严重后果。在讨论光凝术在RVO中治疗NV和黄斑水肿的作用之前，对以下相关问题有基本的科学认识至关重要：RVO的分类、RVO中的眼部NV、黄斑水肿的自然病程以及RVO的视力预后。本文将对这些主题进行讨论。在CRVO中，眼部NV是缺血性CRVO的并发症，而非缺血性CRVO则不会出现。有人主张采用光凝术来预防和/或治疗眼部NV和NVG的发生。由于NVG是缺血性CRVO最可怕、最难治疗且致盲的并发症，因此将讨论光凝术的作用及其治疗方法。本文还将讨论三项关于缺血性CRVO光凝术的随机、前瞻性临床试验结果。同时，也将讨论光凝术在BRVO中治疗眼部NV和黄斑水肿的作用，以及三项针对此的随机、前瞻性临床试验。玻璃体内抗血管内皮生长因子（VEGF）和皮质类固醇疗法的最新出现，极大地改变了光凝术在CRVO和BRVO中治疗黄斑水肿和NV的作用。本文将对此进行详细讨论。
