视网膜静脉阻塞诊疗重在全病程管理

Whole course management is the key to retinal vein occlusion

视网膜静脉阻塞(RVO)是不同原因引起视网膜静脉血液回流受阻导致的视网膜血循环障碍性疾病,其眼部并发症包括黄斑水肿、视网膜缺血和新生血管性青光眼。目前RVO的治疗手段和方法众多,部分医师对各种治疗方法的价值定位不明,甚至只是单纯针对黄斑水肿进行治疗。本文从RVO的病情评估出发,强调RVO的诊疗应建立在针对系统性病因和危险因素的基础上,采取综合策略,同时着眼于其三大眼部并发症制定治疗方案,并定期动态随访观察患眼缺血程度的变化,以完成全病程管理。

Retinal vein occlusion(RVO)is the consequence of obstruction of retinal vein system caused by a variety of etiologies.Its ocular complications include macular edema,retinal ischemia and neovascular glaucoma.Although many drugs for management of RVO are available,some doctors do not fully understand the exact purpose of each treatment.This article starts from the etiology evaluation of RVO,emphasizing that,besides systemic etiology and risk factor management,the treatment of RVO should focus on the three major complications at the same time,rather than just dealing with macular edema.Meanwhile,a regular follow-up for observing the changes of the degree of retinal ischemia is important for whole course management.Anti-vascular endothelial growth factor therapy,the first-line treatment option of RVO,can not only reduce macular edema,but also prevent the complications caused by retinal ischemia and create opportunities for further laser photocoagulation.Laser photocoagulation has an irreplaceable value in the comprehensive treatment of ischemic RVO.Glucocorticoid intraocular implants should not be used alone in the treatment of macular edema secondary to RVO.(Chin J Ophthalmol,2020,56:246-249)