Rehak Matus, Storch Marcus Werner, Hattenbach Lars-Olof, Feltgen Nicolas
Klinik und Poliklinik für Augenheilkunde, Justus-Liebig-Universität und UKGM Gießen, Friedrichstr. 18, 35392, Gießen, Deutschland.
Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland.
Ophthalmologie. 2022 Nov;119(11):1121-1128. doi: 10.1007/s00347-022-01750-z. Epub 2022 Nov 10.
Retinal vein occlusions (RVO) are associated with retinal ischemia to a highly variable extent. An ischemic retina may lead to the development of neovascularization and further to secondary complications such as neovascular glaucoma, vitreous hemorrhage or tractional retinal detachment. Numerous factors such as vascular endothelial growth factor (VEGF) and other cytokines are produced in the ischemic area, which cause macular edema. Before the introduction of intravitreal drug injections (IVI), retinal laser photocoagulation was the leading form of treatment. Macular laser photocoagulation was applied in the form of focal laser or grid laser in patients with branch retinal vein occlusion (BRVO) to treat macular edema. In patients with ischemic RVO, panretinal laser photocoagulation (PRP) was recommended for treatment of secondary neovascular complications. The value of laser treatment in the management of patients with RVO changed after the introduction of IVI treatment.
This article presents a review of the current study results and the recommendations for performing laser photocoagulation of the central and peripheral retina in patients with RVO.
Conventional focal or grid laser photocoagulation has been replaced by IVI treatment in the management of macular edema secondary to BRVO; however, macular laser treatment can still be considered in patients with BRVO if the macular edema persists despite the use of available IVI drugs. The use of central laser photocoagulation in these cases is based on the findings of fluorescein angiography. Disseminated panretinal laser photocoagulation is still indicated in RVO patients who have large areas of nonperfusion, have developed neovascularization and/or late complications. Targeted laser photocoagulation of the peripheral areas of nonperfusion has recently been recommended by several authors and is expected to improve not only the visual outcome of IVI treatment, but more importantly to also reduce the duration of treatment and the number of re-injections needed. Clear evidence for targeted laser treatment is not yet available and is a focus of currently ongoing prospective randomized studies.
视网膜静脉阻塞（RVO）与视网膜缺血的程度高度可变相关。缺血性视网膜可能导致新生血管形成，并进一步引发继发性并发症，如新生血管性青光眼、玻璃体积血或牵拉性视网膜脱离。缺血区域会产生许多因素，如血管内皮生长因子（VEGF）和其他细胞因子，这些会导致黄斑水肿。在玻璃体内药物注射（IVI）引入之前，视网膜激光光凝是主要的治疗形式。黄斑激光光凝以局部激光或格栅激光的形式应用于视网膜分支静脉阻塞（BRVO）患者，以治疗黄斑水肿。对于缺血性RVO患者，推荐全视网膜激光光凝（PRP）治疗继发性新生血管并发症。IVI治疗引入后，激光治疗在RVO患者管理中的价值发生了变化。
本文综述了当前的研究结果以及对RVO患者进行中央和周边视网膜激光光凝的建议。
在治疗BRVO继发的黄斑水肿方面，传统的局部或格栅激光光凝已被IVI治疗所取代；然而，如果尽管使用了现有的IVI药物，黄斑水肿仍持续存在，BRVO患者仍可考虑黄斑激光治疗。这些情况下使用中央激光光凝是基于荧光素血管造影的结果。对于有大面积无灌注、已发生新生血管形成和/或晚期并发症的RVO患者，仍需进行弥漫性全视网膜激光光凝。几位作者最近推荐对周边无灌注区域进行靶向激光光凝，预计这不仅能改善IVI治疗的视力结果，更重要的是还能减少治疗持续时间和所需的再次注射次数。目前尚无靶向激光治疗的确切证据，这是当前正在进行的前瞻性随机研究的重点。
