Usefulness of portal vein pressure for predicting the effects of tolvaptan in cirrhotic patients

AIM: To elucidate influencing factors of treatment response, then tolvaptan has been approved in Japan for liquid retention.METHODS: We herein conducted this study to clarify the influencing factors in 40 patients with decompensated liver cirrhosis complicated by liquid retention. Tolvaptan was administered at a dosage of 7.5 mg once a day for patients with conventional diuretic-resistant hepatic edema for 7 d. At the initiation of tolvaptan, the estimated hepatic venous pressure gradient (HVPG) value which was estimated portal vein pressure was measured using hepatic venous catheterization. We analyzed the effects of tolvaptan and influencing factors associated with treatment response.RESULTS: Subjects comprised patients with a median age of 65 (range, 40-82) years. According to the Child-Pugh classification, class A was 3 patients, class B was 19, and class C was 18. Changes from the baseline in body weight were -1.0 kg (P = 2.04 × 10-6) and -1.3 kg (P = 1.83 × 10-5), respectively. The median HVPG value was 240 (range, 105-580) mmH2O. HVPG was only significant influencing factor of the weight loss effect. When patients with body weight loss of 2 kg or greater from the baseline was defined as responders, receiver operating characteristic curve analysis showed that the optimal HVPG cutoff value was 190 mmH2O in predicting treatment response. The response rate was 87.5% (7/8) in patients with HVPG of 190 mmH2O or less, whereas it was only 12.5% (2/16) in those with HVPG of greater than 190 mmH2O (P = 7.46 × 10-4). We compared each characteristics factors between responders and non-responders. As a result, HVPG (P = 0.045) and serum hyaluronic acid (P = 0.017) were detected as useful factors.CONCLUSION: The present study suggests that tolvaptan in the treatment of liquid retention could be more effective for patients with lower portal vein pressure.

Subharmonic scattering of ultrasound contrast agent microbubbles may be an effective and promising tool for portal vein pressure estimation

Portal hypertension(PH)is a commonly observed syndrome in patients with cirrhosis and other chronic liver diseases(1).It is closely associated with severe clinical complications,including upper gastrointestinal hemorrhage,ascites,hepatic encephalopathy,and liver failure(2-6).Portal vein pressure(PVP)is a prognostic indicator for patients with cirrhosis,and PH is a contraindication for hepatectomy(7,8).Currently,the gold standard for assessing PVP is the measurement of PVP gradient[hepatic venous pressure gradient(HVPG)],which is indirectly determined by placing a catheter in the hepatic vein(3).

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

BACKGROUND Heart failure(HF)causes extracardiac organ congestion,including in the hepatic portal system.Reducing venous congestion is essential for HF treatment,but evaluating venous congestion is sometimes difficult in patients with chronic HF.The portal vein(PV)flow pattern can be influenced by right atrial pressure.Ultrasound images of the PV are quite easy to obtain and are reproducible among sonographers.However,the association between PV pulsatility and the condition of HF remains unclear.We hypothesize that PV pulsatility at discharge reflects the condition of HF.AIM To evaluate the usefulness of PV pulsatility as a prognostic marker for hospit-alized patients with acute HF.METHODS This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko Hospital.We enrolled 56 patients with acute HF,and 17 patients without HF served as controls.PV flow velocity was mea-sured by ultrasonography on admission and at discharge.We calculated the PV pulsatility ratio(PVPR)as the ratio of the difference between the peak and minimum velocity to the peak velocity.The primary endpoint was cardiac death and HF re-hospitalization.The observation period was 1 year from the first hospitalization.The Kaplan-Meier method was used to determine the stratified composite event-free rates,and the log-rank test was used for comparisons between groups.RESULTS On admission,the PVPR was significantly higher in patients with acute HF than controls(HF:0.29±0.20 vs controls:0.08±0.07,P<0.01).However,the PVPR was significantly decreased after the improvement in HF(admission:0.29±0.20 vs discharge:0.18±0.15,P<0.01)due to the increase in minimum velocity(admission:12.6±4.5 vs discharge:14.6±4.6 cm/s,P=0.03).To elucidate the association between the PVPR and cardiovascular outcomes,the patients were divided into three groups according to the PVPR tertile at discharge(PVPR-T1:0≤PVPR≤0.08,PVPR-T2:0.08<PVPR≤0.21,PVPR-T3:PVPR>0.21).The Kaplan-Meier analysis showed that patients with a higher PVPR at discharge had the worst prognosis among the groups.CONCLUSION PVPR at discharge reflects the condition of HF.It is also a novel prognostic marker for hospitalized patients with acute HF.

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

Intraocular pressure(IOP)modifications in patients with acute central/hemicentral retinal vein occlusions(RVOs)consist in IOP reductions and increases.The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor,that increases gradually until 3 mo after the venous occlusion onset,and then finally disappears after month 4 th.The IOP increases lead to the ocular hypertension and glaucoma.The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups:1)the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis;2)the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance(ocular hypertension,primary angle-closure,primary angle-closure glaucoma,and open angle glaucomas);and 3)the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations,lacking a causal connection between the 2 conditions.

Short-term fluctuation of intraocular pressure and influencing factors following intravitreal injection in patients with retinal vascular diseases

AIM:To investigate the patterns of short-term intraocular pressure(IOP)fluctuations and identify the contributing factors following intravitreal injection in patients with retinal vascular diseases.METHODS:Totally 81 patients were enrolled in this case control study.Eyes were categorized into 7 groups,including age-related macular degeneration(AMD),polypoidal choroidal vasculopathy(PCV),idiopathic choroidal neovascularization(CNV),proliferative diabetic retinopathy(PDR),diabetic macular edema(DME),macular edema secondary to branch(BVOME)and central(CVOME)retinal vein occlusion.IOP was measured in all patients using rebound tonometer at 7 preset time points perioperatively.Additionally,based on the administered medication,the eyes were classified into three treatment groups,including dexamethasone intravitreal implant(IVO),intravitreal conbercept(IVC),and intravitreal ranibizumab(IVR).To compare IOP values at various time points across groups,we employed one-way ANOVA,independent sample t-test or χ^(2) test and multivariate logistic regression analysis.RESULTS:Peak IOP values across all groups were observed at 40s,and 5min after intravitreal injection.Statistical differences in IOP were detected at the 5min among the 7 indication groups(F=2.50,P=0.029).When examing the impact of medications,the IVO group exhibited lower average IOP values at both 40s and 5min compared to the IVC and IVR groups(P<0.001;P=0.007).The IOP values at 40s and 5min were significantly higher in BVOME and CVOME group compared to non-retinal vein occlusionsecondary macular edema(RVOME)group(P<0.001).Multivariate logistic regression analysis further confirmed that IOP measurement at 40s was significantly higher in CVOME group than in non-RVOME group(OR=1.64,95%CI:1.09-2.47;P=0.018).CONCLUSION:Needle size plays a crucial role in the transient changes of IOP following intravitreal injection.Before administering intravitreal injection to patients with central retinal vein occlusion,it is essential to exclude any underlysing causes of increased IOP.

Ultrasound based estimate of central venous pressure:Are we any closer?

Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance.Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances.Elevated CVP can lead to fluid accumulation in the interstitial space,impairing venous return and reducing cardiac preload.While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate,they carry risk of complications and their usage has not shown clinical improvement.Ultrasound-based assessment of the internal jugular vein(IJV)offers real-time,non-invasive measurement of static and dynamic parameters for estimating CVP.IJV parameters,including diameter and ratio,has demonstrated good correlation with CVP.Despite significant advancements in non-invasive CVP measurement,a reliable tool is yet to be found.Present methods can offer reasonable guidance in assessing CVP,provided their limitations are acknowledged.

Mechanical instability of veins under internal pressure

Introduction Tortuous veins are often seen in the retina,cerebrum,and human legs. Venous tortuosity may affect blood flow and the wall remodeling process,both of which are associated with venous diseases. It has been shown that tortuous or vari-

Radial Artery and Saphenous Vein Grafts in Coronary Artery Bypass Surgery Comparison in Terms of Patient Symptoms

Background: The aim of this study is to compare radial artery with saphenous vein grafts which are widely used for coronary bypass, from views of patients’ satisfaction and postoperative findings. Methods: 42 isolated coronary bypass (CABG) patients performed during November 2012-April 2013 are included in the study. 30 days after the operation, in patients who had both RA and SV removal made responses to a questionnaire form which included 6 questions about symptoms of extremity. Results: After analyzing the responses and physical examination, there was no difference in terms of quality of life and usefulness of the extremity for daily use between two grafts. 2 patients (2%) have wound infection on the saphenous vein incision and additional surgical procedure was performed and a scar tissue has occurred. There was no statistically significance between uncomfortable symptoms and demographic data. Conclusion: Our study suggested that RA graft using showed a bit more comfortable and suitable effect against SV in our patients. We think that radial arterial grafts should be used more widely in coronary surgery with selected patients.

Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient

BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread use.AIM To investigate the correlation of computed tomography(CT)perfusion parameters with HVPG in PH,and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt(TIPS).METHODS Twenty-four PH related gastrointestinal bleeding patients were recruited in this study,and all patients were performed perfusion CT before and after TIPS surgery within 2 wk.Quantitative parameters of CT perfusion,including liver blood volume(LBV),liver blood flow(LBF),hepatic arterial fraction(HAF),spleen blood volume(SBV)and spleen blood flow(SBF),were measured and compared before and after TIPS,and the quantitative parameters between clinically significant PH(CSPH)and non-CSPH(NCSPH)group were also compared.Then the correlation of CT perfusion parameters with HVPG were analyzed,with statistical significance as P<0.05.RESULTS For all 24 PH patients after TIPS,CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared withNCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAFbefore TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation wasfound in other CT perfusion parameters with HVPG and Child-Pugh scores.CONCLUSIONHAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH thanNCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found afterTIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.

Splenectomy in living donor liver transplantation and risk factors of portal vein thrombosis

Background:Graft inflow modulation(GIM)during adult-to-adult living donor liver transplantation(LDLT)is a common strategy to avoid small-for-size syndrome,and some transplant surgeons attempt small size graft strategy with frequent GIM procedures,which are mostly performed by splenectomy,in LDLT.However,splenectomy can cause serious complications such as portal vein thrombosis and overwhelming postsplenectomy infection.Methods:Forty-eight adult-to-adult LDLT recipients were enrolled in this study and retrospectively reviewed.We applied the graft selection criteria,which routinely fulfill graft-to-recipient weight ratio≥0.8%,and consider GIM as a backup strategy for high portal venous pressure(PVP).Results:In our current strategy of LDLT,splenectomy was performed mostly due to hepatitis C and splenic arterial aneurysms,but splenectomy for GIM was intended to only one patient(2.1%).The final PVP values≤20 mmHg were achieved in all recipients,and no significant difference was observed in patient survival or postoperative clinical course based on whether splenectomy was performed or not.However,6 of 18 patients with splenectomy(33.3%)developed postsplenectomy portal vein thrombosis(PVT),while none of the 30 patients without splenectomy developed PVT after LDLT.Splenectomy was identified as a risk factor of PVT in this study(P<0.001).Our study revealed that a lower final PVP could be risk factor of postsplenectomy PVT.Conclusions:Using sufficient size grafts was one of the direct solutions to control PVP,and allowed GIM to be reserved as a backup procedure.Splenectomy should be avoided as much as possible during LDLT because splenectomy was found to be a definite risk factor of PVT.In splenectomy cases with a lower final PVP,a close follow-up is required for early detection and treatment of PVT.

Ocular hypertension in patients with central/hemicentral retinal vein occlusions： cumulative prevalence and management

AIM： To prospectively evaluate the cumulative prevalence and the management of ocular hypertension（OH） in patients with unilateral acute central/hemicentral retinal vein occlusions（C/HCRVOs） over the course of 3 y. METHODS： The study included 57 patients with unilateral acute C/HCRVOs. All patients underwent a comprehensive ophthalmological examination of both eyes. OH associated with C/HCRVO in patients showing a score 〉5% for the risk of conversion to primary open angle glaucoma（POAG） was treated with OH medication. The treatment aimed for a decrease in intraocular pressure（IOP） to 〈21 mm Hg with a 〉22% reduction from the initial values. The cumulative prevalence of OH and the effectiveness of treatment assessed by the cumulative prevalence of conversion from OH to POAG, were estimated. RESULTS： Fifteen patients had OH associated with C/HCRVOs, the cumulative prevalence of OH was 29.4%（95% confidence interval, 16.9-41.9）. The mean value of the risk score of OH conversion to POAG for the 5 subsequent years was 11.7%±5.4%. The IOP significantly decreased from 25.67±2.16 mm Hg to 18.73±2.96 mm Hg. None of the OH patients converted to POAG during the follow-up period. CONCLUSION： The increased cumulative prevalence of OH in C/HCRVO patients indicates that OH is a risk factor for the appearance of venous occlusion. Patients with OH associated with C/HCRVO must be considered to be at high risk for conversion to POAG. Treatment with OH medications prevented conversion to POAG during the 3-year follow-up.

Atypical clinical and pathological findings in a patient with isolated cortical vein thrombosis

Isolated cortical vein thrombosis often produces a focal lesion. Because of the rapid development of collateral circulation, increased intracranial pressure has never been reported in a patient with isolated cortical vein thrombosis. The diagnosis of isolated cortical vein thrombosis is based mainly on MRI, catheter digital subtraction angiography, and histological findings, but may be challenging. We report a patient who presented with intermittent seizures and left-sided limb weakness. Her symptoms gradually progressed, and she eventually developed signs of increased intracranial pressure. Imaging studies showed a space-occupying lesion in the right frontal lobe of the brain. As we could not diagnose isolated cortical vein thrombosis based on the preoperative findings, surgical excision of the lesion was performed under general anesthesia. Histological examination showed destruction of the brain parenchyma with infiltration of macrophages, proliferation of reactive astrocytes and small vessels, and foci of hemorrhage. Further examination found that a number of small vessels in both the subarachnoid space and brain parenchyma were filled with thrombus, some of which was organized. Elastic fiber staining showed that the obstructed vessels were veins. We diagnosed isolated cortical vein thrombosis with atypical clinical features.

Effect of Head Position Angles on the Blood Flow in the Jugular Vein of Giraffes

The study investigated the effect of the angular position of the head on the blood flow in the jugular vein of giraffes. The vein considered is elastic and collapsible such that its cross-sectional area is not uniform. Transmural pressure causes the blood to move along the vein. Mathematical equations describing the flow were developed, and the vein was considered to be inclined at an angle φ to the horizontal. A finite-difference scheme was used to solve the equations of motion for the flow. The results are presented via relevant tables and plots. Our findings show that a change in the position of the head causes variation in the external pressure, which in turn causes variation in the cross-sectional area of the vein. Moreover, a drop (or increase) in the inertial pressure of the blood may cause the vein to collapse (or distend), which again triggers a change in the pressure.

EVALUATION OF RAT MODEL OF CHRONIC GLAUCOMA BY LIGATING EPISCLERAL VEINS

Objective To develop and evaluate the rat model of chronic glaucoma by episcleral veins ligation （EVL）. Methods Experimental glaucoma was induced unilaterally in 28 male Sprague-Dawley rats by ligating two episcleral veins. Intraocular pressure （10P） in rats was measured by a Goldmann applanation tonometer under 3 % pentobarbital sodium anesthesia. The optic nerve head and retinal vasculature were assessed by repeated fundus examinations. The amount of optic nerve axons was assessed by Image-Pro Plus image analysis system in a masked fashion. Results lOP without EVL was （ 19.21 ± 1.23） mmHg, whereas the EVL eyes gained about 1.8-fold higher 10P[ （33.96 ±2. 73） mmHg]after EVL immediately （ P 〈 0. 001 ）. The elevated IOP gradually decreased over time. However, the differences were kept significant up to 8 weeks after EVL. The lOP was reduced to similar levels as contralateral eyes at 12 and 16 weeks after EVL. The glaucomatous optic nerve excavation appeared in EVL eyes at 8 weeks after EVL, and the optic nerve excavation enlarged gradually with the increasing post-operation time. The amount of optic nerve axons also significantly decreased in EVL eyes at 8 weeks after EVL, and the amount of axons decreased gradually with the increasing post-operation time. Conclusion Increase of lOP caused by EVL represents a useful and efficient model of experimental glaucoma in rats.

Endoscopic ultrasound-guided portal pressure gradient measurement in managing portal hypertension

Portal hypertension(PH)is still a challenging clinical condition due to its silent manifestations in the early stage and needs to be measured accurately for early detection.Hepatic vein pressure gradient measurement has been considered as the gold standard measurement for PH;however,it needs special skill,experience,and high expertise.Recently,there has been an innovative development in using endoscopic ultrasound(EUS)for the diagnosis and management of liver diseases,including portal pressure measurement,which is commonly known as EUS-guided portal pressure gradient(EUS-PPG)mea-surement.EUS-PPG measurement can be performed concomitantly with EUS evaluation for deep esophageal varices,EUS-guided liver biopsy,and EUS-guided cyanoacrylate injection.However,there are still major issues,such as different etiologies of liver disease,procedural training,expertise,availability,and cost-effectiveness in several situations with regard to the standard management.

基于Caprini量表评估干预措施结合空气波压力治疗仪对乳腺癌术后患者下肢深静脉血栓形成的影响

目的探讨基于Caprini量表评估干预措施结合空气波压力治疗仪对乳腺癌术后患者下肢深静脉血栓(DVT)形成的影响。方法选取2020年3月至2023年9月合肥市第二人民医院收治的80例乳腺癌术后患者,按照入院时间分为两组。入院时间2020年3月至2022年3月为常规组,入院时间2022年4月至2023年9月为干预组,各40例。常规组行基于Caprini量表评估预防护理,干预组在常规组的基础上实施空气波压力治疗仪干预。观察两组DVT发生率,比较两组干预前后世界卫生组织生存质量测定量表简表评分及满意度。结果干预组术后下肢DVT发生率低于常规组,差异有统计学意义(P<0.05)。干预前,两组生理领域、心理领域、环境领域、社会关系领域评分比较,差异无统计学意义(P>0.05);干预后,两组生理领域、心理领域、环境领域、社会关系领域评分高于干预前,且干预组高于常规组,差异有统计学意义(P<0.05)。干预组护理满意度优于常规组,差异有统计学意义(P<0.05)。结论乳腺癌患者术后实施基于Caprini量表评估干预措施结合空气波压力治疗仪干预,可明显提高下肢DVT预防效果,降低下肢DVT发生率,提高生活质量及满意度高。

耳穴压籽联合低频电穴位刺激对髋、膝关节术后深静脉血栓形成预防效果观察

[目的]观察耳穴压籽联合低频电穴位刺激对髋、膝关节术后深静脉血栓(DVT)形成预防效果。[方法]选定天津中医药大学第二附属医院2018年8月—2023年8月就诊的120例髋、膝关节手术患者,以随机数字表法随机将其分为2组,各60例,对照组给予利伐沙班治疗,观察组在对照组的基础上给予低频电穴位刺激联合耳穴压籽治疗,两组均在治疗7 d后进行疗效评价,比较两组血栓弹力图(TEG)参数、凝血功能指标、患肢周径差值、患肢肿胀程度、视觉模拟自评量表(VAS)评分、DVT发生率。[结果]观察组治疗后凝血指数(CI)、最大振幅(MA)、血凝块聚合形成速率(α角)均低于对照组,差异有统计学意义(P<0.05),观察组治疗后凝血时间(K)、反应时间(R)均高于对照组,差异有统计学意义(P<0.05)。观察组治疗后D-二聚体(D-D)、纤维蛋白原(FIB)均低于对照组,差异有统计学意义(P<0.05),观察组治疗后部分凝血酶原时间(APTT)、凝血酶原时间(PT)均高于对照组,差异有统计学意义(P<0.05)。观察组治疗后大腿、小腿周径差值均低于对照组,差异有统计学意义(P<0.05)。观察组患肢肿胀程度轻于对照组,差异有统计学意义(P<0.05)。观察组治疗后VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组DVT发生率(1.67%)低于对照组(13.33%),差异有统计学意义(P<0.05)。[结论]耳穴压籽联合低频电穴位刺激可有效改善髋、膝关节手术患者术后凝血功能,缓解肢体肿胀、疼痛等症状,缩小患肢周径差,降低DVT发生率。

气压治疗仪护理模式对重症医学科患者深静脉血栓形成的预防作用

目的探讨气压治疗仪护理模式对重症医学科患者深静脉血栓形成的预防效果。方法选取2019年7月至2021年11月常州市第三人民医院重症医学科收治的98例患者作为研究对象,按随机数字表法分为两组,每组49例。对照组采取常规护理,观察组在常规护理基础上采取气压治疗仪护理模式,比较两组凝血指标、静脉血流速度、深静脉血栓形成风险及深静脉血栓发生率。结果护理后,观察组血浆纤维蛋白原(Fg)、D二聚体(D-D)水平均低于对照组,血浆活化部分凝血酶时间(APTT)、血浆凝血酶原时间(PT)水平均长于对照组,差异有统计学意义(P<0.05);护理后,观察组胫后静脉、腘静脉、股深静脉的血流速度均快于对照组,差异有统计学意义(P<0.05);护理后7 d,观察组静脉血栓形成危险度评分量表(RAPT)风险分级低于对照组,差异有统计学意义(P<0.05);观察组深静脉血栓发生率为4.08%,低于对照组的16.33%,差异有统计学意义(P<0.05)。结论气压治疗仪护理模式应用于重症医学科患者中,可有效改善其凝血指标,减缓下肢静脉血流速度,降低深静脉血栓形成风险,从而有效预防深静脉血栓形成。

无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞继发黄斑水肿患者中的应用分析

目的 探讨无灌注区、黄斑区双激光方案在视网膜静脉分枝阻塞(BRVO)继发黄斑水肿(ME)患者中的应用分析。方法 根据随机数字表法将浙江省丽水市人民医院2021年5月至2022年5月收治的150例BRVO继发ME患者分为对照组(雷珠单抗玻璃体腔内注射治疗)和双激光组(雷珠单抗联合无灌注区、黄斑区双激光治疗),各75例。治疗后3个月,比较两组临床效果、恢复情况[最佳矫正视力(BCVA)、眼内压(IOP)、黄斑中心视网膜厚度(CMT)]、黄斑区血流情况及荧光素眼底血管造影检查结果。结果 双激光组疗效优于对照组(P<0.05)。治疗后3个月,两组BCVA高于治疗前,IOP、CMT低于治疗前,且双激光组BCVA高于对照组,IOR、CMT低于对照组(P<0.05)。治疗后3个月,两组浅、深层毛细血管血流密度均高于治疗前,且双激光组高于对照组(P<0.05)。双激光组囊样渗漏、弥漫渗漏、局部渗漏发生率均低于对照组(P<0.05)。结论 玻璃体腔内注射雷珠单抗联合无灌注区、黄斑区双激光治疗BRVO继发ME可提高雷珠单抗的效果,促进患者视力恢复,还可改善黄斑区血流状况,减少血管渗漏发生。