Hattenbach Lars-Olof, Chronopoulos Argyrios, Feltgen Nicolas
Augenklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
Universitäts-Augenklinik Göttingen, Göttingen, Deutschland.
Ophthalmologie. 2022 Nov;119(11):1100-1110. doi: 10.1007/s00347-022-01735-y. Epub 2022 Oct 14.
Intravitreal injection treatment for the management of macular edema as an expression of increased capillary permeability and leakage constitute the mainstay of treatment in retinal vein occlusion. In contrast to diabetic retinopathy or neovascular age-related macular degeneration, permanent and complete functional and morphological restoration can be achieved, as retinal vein occlusions are usually associated with risk factors, but do not represent the manifestation form of an underlying systemic or degenerative chronic disorder; however, successful long-term management of retinal vein occlusion -associated macular edema usually requires intensive and also long-term continued treatment with vascular endothelial growth factor (VEGF) inhibitors or with a less favorable side effect profile, dexamethasone. A functional treatment success can be maintained over the long term by both pro re nata (PRN) or treat and extend (T&E) regimens. In contrast, according to the currently available data, the combination of anti-VEGF administration and grid laser treatment has no additional benefit compared to monotherapy. In patients with recalcitrant macular edema, switching to another intravitreal agent may be considered during the course of treatment, although a true therapeutic benefit with respect to the development of visual acuity has not yet been proven. The current review summarizes the relevant aspects in the management of RVO-associated macular edema and provides the foundations for the application of successful treatment strategies.
玻璃体内注射治疗黄斑水肿作为毛细血管通透性增加和渗漏的一种表现，是视网膜静脉阻塞治疗的主要手段。与糖尿病视网膜病变或新生血管性年龄相关性黄斑变性不同，视网膜静脉阻塞通常与危险因素相关，但并非潜在系统性或退行性慢性疾病的表现形式，因此可以实现永久性和完全的功能及形态恢复；然而，成功长期管理视网膜静脉阻塞相关黄斑水肿通常需要使用血管内皮生长因子（VEGF）抑制剂进行强化且长期的持续治疗，或者使用副作用相对较差的地塞米松。通过按需（PRN）或治疗并延长（T&E）方案均可长期维持功能性治疗成功。相比之下，根据目前可得数据，抗VEGF给药与格栅样激光治疗联合使用相较于单一疗法并无额外益处。对于顽固性黄斑水肿患者，尽管尚未证实对视力发展有真正治疗益处，但在治疗过程中可考虑换用另一种玻璃体内注射药物。本综述总结了视网膜静脉阻塞相关黄斑水肿管理的相关方面，并为成功治疗策略的应用提供了基础。
