The Electroretinogram in Patients with Retinal Vascular Occlusion

Purpose: to measure and analyze the electroretinogram (ERG) in patients with retinal vascular occlusion. Method: fifty-eight cases (59 eyes) of retinal vascular occlusion and the fellow eyes of 47 cases were tested with Ganzfeld ERG. The scotopic and photopic ERG, and oscillatory potentials were tested according to the ERG standard of ISCEV. Results: The abnormal rates of Ops and b wave were higher in retinal vascular occlusion. The abnormal ERG appeared mostly in CRVO among four types of retinal vascular occlusion. The comparisons of some amplitudes and latencies between the fellow eyes and the affected eyes showed statistically significant difference. Conclusion: The oscillatory potentials and b waves have important roles in evaluating the retinal function of patients with retinal vascular occlusions. There are some clinical significance for comparing ERG between the affected eye and the fellow eye. Eye Science 2001; 17: 50 ～ 53.

Analysis of Oscillatory Potentials of Flash Electroretinogram in Frequency Domain and Time Domain in Retinal Vein Occlusion

Purpose: To analyse the parameters of frequency domain and time domain of the OPs in branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Methods : OPs from 9 eyes of BRVO, 9 eyes of CRVO and 40 normal control eyes were tested . The frequency spectra of the OPs were derived through Fast Fourier Transform (FFT) . The mean frequency spectra, the total power, the maximum magnitude, the maximum power and the dominant frequency in frequency domain of the OPs from the eyes of BRVO, CRVO and the normal control group were compared with each other. The OPs waveforms were reconstructed with the OPs frequency spectra data by counter-FFT. In time domain, the latencies, the amplitudes and the sum of the amplitudes of the four wavelets of OPs were measured and compared in the above subjects.Results: There were no statistically significant differences in the magnitudes of frequency spectra, the total power, the maximum magnitude and the maximum power in the frequency range from 110 to 250

CHARACTERISTICS OF MULTIFOCAL ELECTRORETINOGRAM IN THE FELLOW EYES OF PATIENTS WITH HIGH MYOPIA WITH RETINAL DETACHMENT

Objective To observe the changes on multifocal electroretinography （MfERG） in the fellow eyes of patients with high myopia without fundus lesions and rhegmatogenous retinal detachment （RRD）. Methods MfERG was performed in 66 patients （ 66 eyes） which were grouped into ： emmetropes （ n = 22 ） as the control eye ; high myopes without fundus lesions （ corrected visual acuity ≥ 1. 0, n = 15 ） ; and fellow eyes of high myopics with RRD （n = 29 ）. The first-order kernels N1, P1, N2 response density and latency were analyzed. Results When compared with the emmetropes group, the high myopes group had significantly reduced N1 , PI , and N2 wave response densities in rings 1 to 6 （ P 〈 0. 05 ）, delayed N1 wave latency in rings 3 to 6, and P1 wave latency in rings 3 to 5 （ P 〈 0. 05 ）. The fellow eyes group had significantly reduced N1, P1, and N2 wave response densities in rings 1 to 6 and significantly delayed N1 and P1 wave latencies in rings 3 to 6 （ P 〈0. 05） compared with the emmetropes group. Compared with the high myopes group, P1 wave response densities in rings 1 to 6, N1 wave response densities in rings 1,3, 4, and 6, and N2 wave response density in ring 1 were significantly decreased in the fellow eyes group （ P 〈 0. 05 ） ; whereas there were no significant differences in latencies between the two groups （P 〉0.05）. Conclusion MfERG can sensitively assess the early changes in visual function in fellow eyes in patients with RRD.

Effect of a novel tyrosine kinase inhibitor nintedanib on bFGF and VEGF concentrations in a rabbit retinal vein occlusion model

AIM:To evaluate whether a novel tyrosine kinase inhibitor nintedanib could inhibit basic fibroblast growth factor(bFGF)and vascular endothelial growth factor(VEGF)simultaneously for retinal vascular disease in vivo.METHODS:After a laser induced rabbit retinal vein occlusion(RVO)model was made,0.5 mg of nintedanib was injected intravitreally in the left eye on the third day while the right eye was as a control.Intracameral samples were taken on the day before laser treatment and days 1,3,7,14,21,and 28 after treatment.Enzyme-linked immunosorbent assay(ELISA)was used to test the bFGF and VEGF-A concentrations in the aqueous humor.RESULTS:Both bFGF and VEGF-A rose significantly on the third day after laser treatment in both eyes.In the control eye the bFGF concentration peaked on the 14th day while the VEGF-A concentration dropped rapidly soon after the third day.After nintadanib injection in the study eye,both bFGF and VEGF-A showed a significant reduction on the 4th day(7th day after laser treatment)when compared to the control eye,and kept on low level in the following several weeks.CONCLUSION:Intravitreal injection of nintedanib can inhibit the expression of bFGF and VEGF in the process of RVO model to a certain extent,which is expected to become a new method for the treatment of retinal vascular diseases or fibrotic diseases.

Anomalous retinal artery associated with branch retinal artery occlusion and neovascular glaucoma: A case report

BACKGROUND Congenital anomalous retinal artery is rare and does not typically affect visual acuity.However,an abnormal artery that passes through and supplies blood to the macular area complicated with branch retinal artery occlusion may negatively impact visual acuity.This study reports an unusual case of anomalous retinal artery combined with retinal artery occlusion.CASE SUMMARY A 52-year-old male presented with severely reduced vision in the right eye.The fundus examination revealed an anomalous artery,extending from the superior temporal arcade and crossing the macula into the inferior temporal quadrant.The anomalous artery was partially occluded,with a narrowed lumen.A cherry-red spot was observed with whitening of the macular area,suggesting macular edema.Fundus fluorescein angiography revealed disc leakage and a delayed filling time.Optical coherence tomography revealed increased thickness of the neuroretina and underlying layers.The patient was treated with vessel dilation,hyperbaric oxygen,ocular massage,and thrombolytics.Visual acuity of the right eye subsequently improved to 20/200 from hand motion at 4 cm.This improvement in visual acuity persisted when the patient was examined at the 1-mo follow-up visit.The patient was subsequently followed via telephone interview.The information provided via interview indicated that visual acuity in the affected eye was stable up to 6 years from the time of the initial presentation.However,after 3 additional years,the patient was diagnosed with neovascular glaucoma in the right eye,which was subsequently enucleated.CONCLUSION Although congenital retinal vascular anomaly,including anomalous retinal artery,rarely affects vision,when complicated with branch retinal artery occlusion,the abnormal artery that supplies the macula may severely reduce visual acuity.

Intravitreal anti-VEGF agents, oral glucocorticoids, and laser photocoagulation combination therapy for macular edema secondary to retinal vein occlusion: preliminary report

AIM： To evaluate the efficacy and safety of combined anti-vascular endothelial growth factor （VEGF） agents, oral glucocorticoid, and laser photocoagulation therapy for macular edema （ME） secondary to retinal vein occlusion （RVO）. METHODS： This study included 16 eyes of 16 patients with RVO-associated ME. Patients were initially treated with oral prednisone and an intravitreal anti-VEGF agent. Two weeks later, patients underwent standard laser photocoagulation. Best-corrected visual acuity （BCVA）, central retinal thickness （CRT）, and retinal vessel oxygenation were examined over 12mo. RESULTS： Patients received 1.43＋0.81 anti-VEGF injections. Mean baseline and 12-month IogMAR BCVA were 0.96±0.51 （20/178） and 0.31±0.88 （20/40）, respectively, in eyes with central retinal vein occlusion （CRVO） （P〈0.00）, and 1.02±0.45 （201209） and 0.60±0.49 （20/80）, respectively, in eyes with branch retinal vein occlusion （BRVO） （P〈0.00）. At 12mo, CRT had significantly decreased in eyes with CRVO （P〈0.00） and BRVO （P〈0.00）. Venous oxygen saturation had significantly increased in eyes with CRVO （P〈0.00） and BRVO （P〈0.00）. No examined parameters were significantly different between the 2 RVO groups. No serious adverse effects occurred. CONCLUSION： Anti-VEGF, glucocorticoid, and photocoagulation combination therapy improves visual outcome, prolongs therapeutic effect, and reduces the number of intravitreal injections in eyes with RVO- associated ME.

Treatment Options of Macular Edema Secondary to Retinal Vein Occlusion (RVO): A Review

Retinal Vein Occlusion (RVO) is a common retinal vascular disease secondary to diabetic retinopathy resulting in permanent loss of vision despite available treatment options. Main vision impending complication of retinal vein occlusion is macular edema. Laser photocoagulation has been an established method for treating macular edema for many years but nowadays intravitreal injection of Anti-Vascular endothelial growth factors (Ranibizumab, Aflibercept Bevacizumab and Pegaptanib sodium) is the treatment of choice for macular edema from retinal vein occlusion. Intra-vitreal corticosteroids Triamcinolone Acetonide and Dexamethasone implant, are also being used to treat in some macular edema cases but with higher rates of side effects. Numerous surgical methods have been attempted for treating RVO and preventing macular edema;they include pars plana vitrectomy, radial optic neurotomy, laser induced chorioretinal anastomosis, and arteriovenous sheathotomy. Surgical methods supposedly relieve compression of the central retinal vein, altering the pathophysiology of vein occlusion at the level of the lamina cribrosa thus improving blood flow and oxygenation. But limitations result from its complications.

Efficacy of intravitreal conbercept injection on short-and long-term macular edema in branch retinal vein occlusion

AIM: To observe the best-corrected visual acuity(BCVA) and central foveal thickness(CFT) repeatedly after the intravitreal injection of conbercept(IVC) for treating cystoid macular edema(CME) in branch retinal vein occlusion(BRVO) and explore the relationship between the duration of CME and visual outcome.METHODS: Subgroup analysis was performed to compare short-term(within 90 d of CME onset) and longterm(over 90 d of CME onset) macular edema in BRVO.After an initial IVC, a pro re nata(PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA.Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6 mo after IVC.RESULTS: Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME.There were statistical significances between and within groups of the BCVAs at different time points(P<0.001).The interaction was found between group and time(P=0.006), indicating the difference in the speed of BCVA improvement between groups.In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group.There were significant differences between and with groups of the CFT at different time points(P<0.001).However, the interaction between group and time in relation to CFT had no significant differences(P=0.59).CONCLUSION: IVC treatment for CME following BRVO is effective and safe.The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO.The improvement of vision might be faster with early IVC treatment than with delayed treatment.

Altered brain network centrality in patients with retinal vein occlusion: a resting-state fMRI study

AIM:To explore the intrinsic brain activity variations in retinal vein occlusion(RVO)subjects by using the voxel-wise degree centrality(DC)technique.METHODS:Twenty-one subjects with RVO and twentyone healthy controls(HCs)were enlisted and underwent the resting-state functional magnetic resonance imaging(rs-f MRI)examination.The spontaneous cerebrum activity variations were inspected using the DC technology.The receiver operating characteristic(ROC)curve was implemented to distinguish the DC values of RVOs from HCs.The relationships between DC signal of definite regions of interest and the clinical characteristics in RVO group were evaluated by Pearson’s correlation analysis.RESULTS:RVOs showed notably higher DC signals in right superior parietal lobule,middle frontal gyrus and left precuneus,but decreased DC signals in left middle temporal gyrus and bilateral anterior cingulated(BAC)when comparing with HCs.The mean DC value of RVOs in the BAC were negatively correlated with the anxiety and depression scale.CONCLUSION:RVO is associated aberrant intrinsic brain activity patterns in several brain areas including painrelated as well as visual-related regions,which might assist to reveal the latent neural mechanisms.

Intravitreal Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion in Chinese Patients

Purpose: To investigate the short-term efficacy and safety of intravitreal aflibercept in a case series of patients from Taiwan, China, with macular edema secondary to branch retinal vein occlusion(BRVO).Methods: A total of 32 patients with macular edema associated with BRVO,.without prior macular laser or other intervention, were enrolled consecutively from September 2013 to February 2015..The cases received single 2 mg injections of intravitreal aflibercept..Primary outcome measures included changes in central foveal thickness.(CFT;.1 mm increments by spectral-domain optic coherence tomography).and best corrected visual acuity.(BCVA),.determined at 1,.2,.and 3months after the injection. Complications after injections were recorded. The changes in CFT and BCVA were compared with Wilcoxon sign-rank tests.Results:.The CFT was significantly reduced and the BCVA was significantly improved at 1, 2, and 3 months after injection(all P < 0.05). Tomography findings revealed no recurrence within 3 months. No systemic thromboembolic events,elevated intraocular pressure, retinal detachment, or infectious endophthalmitis occurred following injection.Conclusion:.Single intravitreal aflibercept may be useful in treating macular edema associated with BRVO within 3months. No adverse systemic or ocular effects were found in this case series.

Longitudinal analysis of quantitative biomarkers using projection-resolved OCT angiography in retinal vein occlusion

Background:To evaluate a fully automated vascular density(VD),skeletal density(SD)and fractal dimension(FD)method for the longitudinal analysis of retinal vein occlusion(RVO)eyes using projection-resolved optical coherence tomography angiography(OCTA)images and to evaluate the association between these quantitative variables and the visual prognosis in RVO eyes.Methods:Retrospective longitudinal observational case series.Patients presenting with RVO to Creteil University Eye Clinic between October 2014 and December 2018 and healthy controls were retrospectively evaluated.Group 1 consisted of central RVO(CRVO)eyes,group 2 consisted of eyes with branch RVO(BRVO)and group 3 of healthy control eyes.OCTA acquisitions(AngioVue RTVue XR Avanti,Optovue,Inc.,Freemont,CA)were performed at baseline and last follow up visit.VD,SD,and FD analysis were computed on OCTA superficial and deep vascular complex(SVC,DVC)images at baseline and final follow up using an automated algorithm.Logistic regression was performed to find if and which variable(VD,SD,FD)was predictive for the visual outcome.Results:Forty-one eyes,of which 21 consecutive eyes of 20 RVO patients(13 CRVO in group 1,8 BRVO in group 2),and 20 eyes of 20 healthy controls were included.At the level of SVC,VD and FD were significantly lower in RVO eyes compared to controls(P<0.0001 and P=0.0008 respectively).Best-corrected visual acuity(BCVA)at last follow-up visit was associated with baseline VD(P=0.013),FD(P=0.016),and SD(P=0.01)at the level of the SVC,as well as with baseline FD at the DVC level(P=0.046).Conclusions:Baseline VD,SD,and FD are associated with the visual outcome in RVO eyes.These parameters seem valuable biomarkers and may help improve the evaluation and management of RVO patients.

玻璃体腔注射雷珠单抗联合地塞米松缓释剂治疗视网膜静脉阻塞继发黄斑水肿

目的:比较玻璃体腔注射地塞米松缓释剂(Ozurdex)联合雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)与单独使用雷珠单抗治疗的疗效及安全性的差异。方法:选取2020-06/2022-12就诊于我院经眼底血管荧光造影检查确诊为非缺血型RVO-ME的患者,所有患者先行玻璃体腔注射0.5 mg雷珠单抗注射液,2 wk后复查黄斑中心凹视网膜厚度(CRT)≥300μm的42例42眼患者纳入研究,随机分为联合治疗组(21例21眼,即时给予玻璃体腔内注射地塞米松缓释剂)及单药治疗组[21例21眼,仍继续按3+按需(PRN)方式行雷珠单抗注射治疗]。观察治疗前及分组治疗后2 wk,1、2、3、4、5、6 mo的最佳矫正视力(BCVA)、CRT及眼压的改变,并观察眼部及全身并发症的发生情况。结果:分组治疗后2 wk,1、2、3、4、5、6 mo,两组患者BCVA及CRT的改善程度较治疗前显著好转(均P<0.01);治疗后2、3 mo,两组间BCVA及CRT比较有差异(均P<0.05),治疗后2 mo时联合治疗组BCVA字母数增加最明显。单药治疗组黄斑水肿平均复发时间为1.45±0.53 mo,雷珠单抗注射平均4.21±0.78次,两组患者治疗后均未见严重并发症。联合治疗组最常见的并发症为结膜下出血和眼压升高,局部使用降压药后眼压可控制,没有患者需接受抗青光眼及白内障手术。结论:玻璃体腔注射地塞米松缓释剂联合雷珠单抗治疗RVO-ME与单独使用雷珠单抗治疗相比,能显著提高患者的视力,有效减轻黄斑水肿,疗效持续时间长,可有效减少玻璃体腔注药次数。

缺血性视网膜静脉阻塞继发黄斑水肿患者基线血清己糖激酶1抗体滴度与抗VEGF治疗后视力改善的相关性分析

目的分析缺血性视网膜静脉阻塞继发黄斑水肿(RVO-ME)患者基线血清己糖激酶1抗体滴度与抗血管内皮生长因子(VEGF)治疗后视力改善的相关性。方法招募2017年6月至2020年2月在首都医科大学宣武医院确诊为缺血性RVO-ME并接受初始抗VEGF治疗的53例患者,其中缺血性视网膜中央静脉阻塞(CRVO)23例(CRVO组),缺血性视网膜分支静脉阻塞(BRVO)30例(BRVO组)。另选取该院同期30例行超声乳化的白内障患者作为对照组。研究对象行基线血清己糖激酶1抗体滴度检测、眼科常规检查和光学相干断层成像(OCT)检查。所有RVO-ME患者按照“3+按需治疗方案(pro re nata,PRN)”向玻璃体内注射抗VEGF药物治疗。随访12个月,采用多元线性回归分析缺血性RVO-ME患者抗VEGF治疗后视力改善的影响因素。结果CRVO组基线logMAR BCVA高于对照组和BRVO组,CRVO组和BRVO组基线CRT、基线血清己糖激酶1抗体滴度高于对照组,且CRVO组基线CRT、基线血清己糖激酶1抗体滴度高于BRVO组,差异有统计学意义(P<0.05)。RVO-ME患者基线血清己糖激酶1抗体滴度与随访6个月(r=0.377,P=0.005)、9个月(r=0.362,P=0.008)和12个月(r=0.465,P<0.001)时BCVA改善呈正相关,与随访12个月时中断EZ横向长度减少值(r=0.401,P=0.001)呈正相关。多元线性回归分析结果显示,基线logMAR BCVA、基线血清己糖激酶1抗体滴度是缺血性RVO-ME患者抗VEGF治疗随访12个月时BCVA改善的影响因素(P<0.05)。结论己糖激酶1抗体作为一种新的血清生物标志物,与缺血性RVO-ME患者抗VEGF治疗后的视力改善相关。

雷珠单抗联合地塞米松玻璃体内植入剂治疗视网膜分支静脉阻塞继发黄斑水肿的效果

目的观察雷珠单抗联合地塞米松玻璃体内植入剂治疗视网膜分支静脉阻塞继发黄斑水肿(macular edema secondary to branch retinal vein occlusion,BRVO-ME)的效果。方法纳入2020年1月至2022年5月保定市第一中心医院眼科确诊为BRVO-ME且临床资料完整的患者67例67只眼,按照治疗方法的不同将患者分为单药组及联合组,其中单药组37例37只眼,联合组30例30只眼。所有患者行玻璃体腔注射雷珠单抗注射液0.05 mL治疗,联合组于雷珠单抗治疗1周后行地塞米松玻璃体内植入剂0.7 mg玻璃体腔注射;分别于治疗前和治疗后4周检测最佳矫正视力(best corrected visual acuity,BCVA),应用相干光断层扫描成像(optical coherence tomography,OCT)分析黄斑中心凹厚度(central macular thickness,CMT)变化,相干光断层扫描血管成像(optical coherence tomography angiography,OCTA)分析黄斑区浅层视网膜血管灌注密度(vessel perfusion density,VPD)及血管长度密度(vessel length density,VLD)变化。依据患者复诊的情况判断是否需要再次治疗,如果随访复查时OCT的黄斑区域出现视网膜内液或视网膜下液,CMT≥300μm或BCVA持续下降,需再次接受雷珠单抗注射者则终止观察。结果初诊时联合组和单药组BCVA、CMT比较差异无统计学意义(P>0.05),治疗后2组BCVA、CMT较治疗前均降低(P<0.05)且治疗后联合组BCVA、CMT低于单药组(P<0.05)。而2组患者治疗前后黄斑区浅层毛细血管中心、内环、外环及完整的VLD及VPD均无明显变化(P>0.05)。2组治疗前后结果进行组间比较,VLD、VPD结果均无统计学意义(P>0.05)。结论玻璃体腔内注射雷珠单抗联合地塞米松玻璃体内植入剂治疗BRVO-ME可降低黄斑水肿,改善视力及黄斑区结构和功能,并且疗效可持续。但二者早期疗效相似,协同作用不明显。

血清ICAM-1 Hcy及MCP-1水平与视网膜静脉阻塞患者血管内皮功能的相关性

目的:探讨血清细胞间黏附因子-1(Intercellular abhesion molecule-1,ICAM-1),同型半胱氨酸(Homocysteine,Hcy)及单核细胞趋化蛋白-1(Monocyte chemotactic protein-1,MCP-1)水平与视网膜静脉阻塞(Retinal vein occlusion,RVO)患者血管内皮功能的相关性。方法:采用回顾性分析我院在2020年7月至2023年10月期间收治的RVO患者95例为RVO组,另选取同期于本院行体检的健康人群102例作为正常对照组。比较两组ICAM-1、Hcy、MCP-1、血管内皮功能[内皮素-1(Endothelin-1,ET-1)、一氧化氮(Nitric oxide,NO)]水平;比较RVO组不同疾病类型ICAM-1、Hcy、MCP-1、ET-1及NO水平;比较不同病情程度ICAM-1、MCP-1、ET-1及NO水平;分析血清ICAM-1、Hcy、MCP-1水平与RVO患者血管内皮功能的相关性。结果:RVO组血清ICAM-1、Hcy、MCP-1、ET-1水平高于对照组,NO水平低于对照组(P<0.05);CRVO患者的血清ICAM-1、Hcy、MCP-1、ET-1水平高于BRVO患者,NO水平低于BRVO患者(P<0.05);ICAM-1、Hcy、MCP-1、ET-1水平:轻度<中度<重度,NO水平:轻度>中度>重度(P<0.05);血清ICAM-1、Hcy、MCP-1水平与ET-1水平成正相关,与NO水平呈负相关(P<0.05)。结论:血清ICAM-1、Hcy、MCP-1水平在RVO患者中均呈异常升高状态,且与ET-1、NO具有一定的相关性,可通过对血清ICAM-1、Hcy、MCP-1水平的检测用以评估血管内皮功能损伤状况,以便于及早实施治疗。

基于OCTA技术的单侧RVO患者健侧眼黄斑区微血管血流密度、视网膜和脉络膜厚度变化

目的基于光学相干断层扫描血管成像(OCTA)技术,观察单侧视网膜静脉阻塞(RVO)患者健侧眼黄斑区微血管血流密度、视网膜和脉络膜厚度变化。方法单侧RVO患者38例共76只眼,其中患眼38只记为患侧眼组,健侧眼38只记为健侧眼组。另选取同期体检健康者25例的25只正常眼作为对照组。采用美国光视公司RTVue XR 100光学相干断层扫描仪进行黄斑区微血管血流密度、视网膜和脉络膜厚度测量,包括浅层毛细血管丛(SCP)全层、上半侧、下半侧、中心凹、旁中心凹、旁中心凹上半侧、旁中心凹下半侧、旁中心凹颞侧、旁中心凹上方、旁中心凹鼻侧、旁中心凹下方的血流密度(VD),深层毛细血管丛(DCP)全层、上半侧、下半侧、中心凹、旁中心凹、旁中心凹上半侧、旁中心凹下半侧、旁中心凹颞侧、旁中心凹上方、旁中心凹鼻侧、旁中心凹下方的VD,黄斑中心凹无血管区(FAZ)面积和周长、非圆度指数(AI),黄斑中心凹为中心周围300µm区域的视网膜(FD300)的VD,黄斑区视网膜厚度(CMT),黄斑中心凹下脉络膜厚度(SFCT)。结果与对照组组相比,健侧眼组SCP上半侧VD、SCP旁中心凹上半侧VD、DCP旁中心凹VD、DCP旁中心凹上方VD均降低(P均<0.05);与患侧眼组相比,健侧眼组SCP全层VD、SCP上半侧VD、SCP下半侧VD、SCP旁中心凹VD、SCP旁中心凹上半侧VD、SCP旁中心凹下半侧VD、SCP旁中心凹颞侧VD、SCP旁中心凹上方VD、SCP旁中心凹鼻侧VD、SCP旁中心凹下方VD、DCP全层VD、DCP上半侧VD、DCP下半侧VD、DCP旁中心凹VD、DCP旁中心凹上半侧VD、DCP旁中心凹下半侧VD、DCP旁中心凹颞侧VD、DCP旁中心凹上方VD、DCP旁中心凹鼻侧VD、DCP旁中心凹下方VD均升高,SCP中心凹VD、DCP中心凹VD、AI、CMT均降低(P均<0.05)。结论基于OCTA技术观察到单侧RVO患者的健侧眼黄斑区部分微血管血流密度已发生下降,但降低程度不及患侧眼,且健侧眼视网膜和脉络膜厚度变化不明显。

动脉内溶栓治疗视网膜中央动脉阻塞患者的临床特征及功能性视觉恢复单中心研究

目的探讨动脉内溶栓(intra-arterial thrombolysis,IAT)治疗视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)患者的临床特征及功能性视觉恢复情况。方法纳入2018年1月—2023年8月西北大学附属第一医院神经内科和神经眼科连续收治的非动脉炎性CRAO患者,根据入院后是否进行IAT治疗分为IAT组和非IAT组。功能性视觉定义为视力≥20/100。比较分析两组患者的临床特征和不同时间段(入院、出院时和出院1个月时)功能性视觉恢复情况。结果共纳入131例(131只眼)非动脉炎性CRAO患者,男性93例(71.0%),平均年龄为(61.6±12.6)岁,其中IAT组57例(43.5%),非IAT组74例(56.5%)。与非IAT组患者相比,IAT组患者年龄更低[(58.4±12.5)岁vs.(64.1±12.2)岁,P=0.011]、合并卒中病史者比例更低[10(17.5%)vs.25(33.8%),P=0.037]、发病至就诊时间更短[10.0(6.0~24.0)h vs.55.0(20.2~162.0)h,P<0.001]、醒后发病者比例更高[26(45.6%)vs.15(20.3%),P=0.002]和患侧颈内动脉血管状态更佳(无狭窄∶轻度狭窄∶中-重度狭窄∶闭塞=41∶7∶7∶2 vs.32∶11∶21∶10,P=0.006)。IAT组患者出院1个月时功能性视觉比例较非IAT组患者更高[25(43.9%)vs.18(24.3%),P=0.018],而入院和出院时差异无统计学意义(P>0.05)。多因素logistic回归分析显示,IAT组患者出院1个月时的功能性视觉较非IAT组患者显著改善(OR3.24,95%CI1.08~9.69,P=0.036)。IAT组患者术中发生眼动脉痉挛2例(3.5%)、穿刺部位皮肤出血2例(3.5%)和新发脑栓塞(均为无症状性栓塞)事件4例(7.0%)。结论是否进行IAT治疗的CRAO患者部分临床特征存在差异,IAT治疗可显著提高CRAO患者出院1个月时的功能性视觉,且手术安全性较好。提示临床医师需重视CRAO患者的IAT治疗,以期改善患者的视觉功能。

雷珠单抗治疗缺血型和非缺血型视网膜分支静脉阻塞继发黄斑水肿患者视网膜体积变化的对比研究

目的 应用光学相干断层扫描血管成像(OCTA)对比雷珠单抗治疗缺血型和非缺血型视网膜分支静脉阻塞继发黄斑水肿(BRVO-ME)患者的临床疗效和视网膜体积变化的异同。方法 回顾性分析缺血型组34例(34眼)和非缺血型组21例(21眼)的BRVO-ME患者的临床资料,对两组患者均进行玻璃体内注射雷珠单抗治疗,并对治疗前及治疗后1 d、1周、1个月、3个月、6个月患者的最佳矫正视力和黄斑区视网膜体积进行分析。结果 治疗后1 d时最佳矫正视力(logMAR)缺血型组为0.63±0.37,非缺血型组为0.44±0.22,两组相比差异有统计学意义(P=0.017)。视网膜外层、视网膜全层以及视网膜全层Farafovea分区、Perifovea分区的视网膜体积,治疗前缺血型组分别为(6.42±1.90)mm^(3)、(8.75±1.82)mm^(3)、(3.20±0.87)mm^(3)、(5.10±0.89)mm^(3),非缺血型组分别为(5.52±1.57)mm^(3)、(7.83±1.56)mm^(3)、(2.80±0.71)mm^(3)、(4.66±0.77)mm^(3);治疗后1 d缺血型组分别为(4.97±1.18)mm^(3)、(7.46±1.47)mm^(3)、(2.62±0.60)mm^(3)、(4.53±0.80)mm^(3),非缺血型组分别为(4.25±0.48)mm^(3)、(6.58±0.56)mm^(3)、(2.26±0.26)mm^(3)、(4.06±0.40)mm^(3);治疗后1周缺血型组分别为(4.40±0.82)mm^(3)、(6.90±0.85)mm^(3)、(2.38±0.36)mm^(3)、(4.24±0.49)mm^(3),非缺血型组分别为(4.04±0.35)mm^(3)、(6.33±0.49)mm^(3)、(2.15±0.19)mm^(3)、(3.95±0.35)mm^(3),两组相比差异均有统计学意义(均为P<0.05)。视网膜外层和视网膜全层的视网膜体积与基线对比变化量,治疗后1个月时缺血型组分别为(-2.48±2.38)mm^(3)、(-2.54±2.38)mm^(3),非缺血型组分别为(-1.31±1.58)mm^(3)、(-1.38±1.58)mm^(3),两组相比差异均有统计学意义(均为P<0.05)。结论 雷珠单抗治疗缺血型和非缺血型BRVO-ME患者疗效均较好,治疗后短期视力预后非缺血型组较缺血型组患者好,缺血型组患者视网膜体积高于非缺血型组,长期治疗后两组患者视力预后和视网膜体积均无明显差异。

雷珠单抗联合激光治疗视网膜静脉阻塞继发黄斑水肿患者的效果

目的:观察雷珠单抗联合激光治疗视网膜静脉阻塞(RVO)继发黄斑水肿患者的效果。方法:回顾性分析2021年7月至2023年3月该院收治的78例RVO继发黄斑水肿患者的临床资料,根据治疗方案不同将其分为对照组与研究组各39例。对照组采用视网膜激光光凝术治疗,研究组在激光手术前联合玻璃体腔注射雷珠单抗治疗。比较两组临床疗效,治疗前后最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、房水炎性因子[白细胞介素-8(IL-8)、单核细胞趋化蛋白-1(MCP-1)、基质细胞衍生因子-1(SDF-1)]水平、血管内皮生长因子(VEGF)水平,以及并发症发生率。结果:研究组总有效率为92.31%(36/39),高于对照组的74.36%(29/39),差异有统计学意义(P<0.05);治疗3个月后,研究组BCVA、CMT值均小于对照组,房水IL-8、MCP-1、SDF-1、VEGF水平均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为5.13%(2/39),低于对照组的23.08%(9/39),差异有统计学意义(P<0.05)。结论:雷珠单抗联合激光治疗RVO继发黄斑水肿患者效果显著,可减小CMT值,促进视力恢复,降低房水炎性因子、VEGF水平及并发症发生率,效果优于单用激光治疗。