抗血管内皮生长因子药物治疗对视网膜静脉阻塞黄斑水肿患者视网膜毛细血管影响的研究现状

The changes of retinal capillary after anti-vascular endothelial growth factor therapy in patients with macular edema associated with retinal vein occlusion

玻璃体腔注射抗VEGF药物是目前治疗视网膜静脉阻塞(RVO)黄斑水肿的主要手段,其能明显抑制新生血管,减轻水肿,提高患者视力。但VEGF是血管内皮细胞的存活因子,其是否会导致视网膜缺血进展以及是否对视网膜毛细血管产生影响值得临床关注。就目前来看,大多学者认为,从拱环形态改变以及浅层、深层视网膜毛细血管层量化黄斑中心凹无血管区面积、视网膜无灌注区大小及黄斑区视网膜血流密度等方面观察,抗VEGF药物治疗RVO黄斑水肿并不会加重视网膜毛细血管的闭塞。并且,这些指标的变化可能与患者需要治疗的次数、视力预后等有一定的关系。今后随着OCT血管成像的逐渐普及以及抗VEGF药物治疗次数和时间的延长,期待更大样本、更长随访时间的研究深入分析抗VEGF药物治疗对RVO黄斑水肿患者视网膜毛细血管的确切影响。

At present,intravitreal injections of anti-VEGF agents is the main method for the treatment of macular edema secondary to retinal vein occlusion(RVO),which can significantly inhibit neovascularization,release macular edema and improve the vision of patients.However,VEGF is a survival factor of vascular endothelial cells,whether it can lead to the progress of retinal ischemia and it has an effect on retinal capillaries deserves our clinical attention.Most scholars currently think that the anti-VEGF agents will not aggravate the occlusion of retinal capillaries in the treatment of macular edema secondary to RVO from the aspects of the changes of perifoveal capillary arcade,the quantification of foveal avascular zone area,retinal nonperfusion area and retinal vascular density of the superficial and deep capillary plexus In addition,the changes of these indicators may be related to the number of times patients need treatment,visual prognosis and so on.In the future,with the gradual popularization of OCT angiography and the prolongation of the number and time of anti VEGF drug treatment,we look forward to the study of larger samples and longer follow-up time to further analyze the influence of the retinal capillary after anti-VEGF therapy in patients with macular edema associated with RVO.