IRVAN综合征的治疗及其疗效观察

Treatment and therapeutic effect of idiopathic retinal vasculitis,aneurisms and neuroretinitis syndrome

目的:观察分析不同方法治疗特发性视网膜血管炎、动脉瘤、视神经视网膜炎综合征(idiopathic retinal vasculitis,aneurysms and neuroretinitis,IRVAN)的效果。方法:收集经临床确诊的IRVAN综合征患者7例14眼。其中Ⅱ期4眼,Ⅲ期10眼;视力≥0.6者6眼,0.3者4眼,≤0.1者4眼。4眼行视网膜激光光凝无灌注区;Ⅲ期中4眼行全视网膜光凝(PRP),2眼行雷珠单抗玻璃体腔注射联合PRP,4眼行玻璃体切割术联合PRP。随访6mo^10a,观察视力及眼底病变情况。结果:治疗后视力提高者6眼,视力维持不变者6眼,视力提高后又下降者2眼;其中≥0.6者9眼,0.3~0.6者4眼,≤0.1者1眼。Ⅱ期视力稳定4眼,1眼于随访期内出现无灌注区扩大,补充完成PRP后病情稳定;Ⅲ期中4眼行PRP后视力维持不变2眼,视力提高2眼;2眼给予雷珠单抗联合PRP治疗后视力提高;4眼伴玻璃体积血者,治疗后视力提高,其中2眼病情稳定,2眼反复出现玻璃体积血,视力下降。眼底见毛细血管无灌注区封闭,视盘或视网膜新生血管萎缩。结论:Ⅱ期病变行PRP治疗长期效果好;Ⅲ期病变可根据情况给予单独PRP或联合玻璃体切除术或抗VEGF治疗等,但可出现病情反复。早期行PRP治疗可有效控制病变发展。

AIM：To investigate the therapeutic outcomes of idiopathic retinal vasculitis,aneurisms and neuroretinitis（IRVAN） syndrome by different treatments.METHODS：Seven patients（14 eyes） with IRVAN were enrolled in this study and divided into different stages.There were 4 eyes in stage Ⅱ and 10 eyes in stage Ⅲ.The visual acuity（VA） was ≥0.6 in 6 eyes,0.3 in 4 eyes,and≤ 0.1 in 4 eyes.Treatment involved retinal laser photocoagulation for peripheral retinal ischemia area in the 4 eyes in stage Ⅱ and pan retinal laser photocoagulation（PRP） for the 10 eyes in stage Ⅲ.Two eyes in stage Ⅲ were also treated with intravitreal injection of ranibizumab and 4 eyes with vitrectomy before PRP.Visual acuity and fundus situations were measured after the treatments.The follow-up time was 6mo^10a.RESULTS：After treatments,the final VA was improved in 6 eyes,remaining unchanged in 6 eyes,and decreased after improved in 2 eyes.It was as following：≥0.6 in 9eyes,0.3~0.6 in 4 eyes,and ≤0.1 in 1 eyes.Four eyes in stage Ⅱ maintained a good vision,but one of them had a new ischemia area.We treated it with PRP and there was no progression now.In stage Ⅲ,there were 2eyes with unchanged VA,2 eyes with improved VA,2eyes with improved VA after giving ranibizumab,4 eyes with vitreous hemorrhage and with better VA after treatments,and in the 4 eyes,2 eyes kept stable and another two had recurrent vitreous hemorrhage for several times and ended with poor vision.Fundus examination showed the closure of hemorrhage area and optic disc or retinal neovascularization shrinked.CONCLUSION：PRP is effective for eyes in stage Ⅱ.Eyes in stage Ⅲ could be treated with intravitreal injection of ranibizumab or vitrectomy in addition to PRP.Early PRP is effective to stop the progression.