视网膜静脉阻塞合并黄斑水肿的治疗与展望

doi:10.3969/j.issn.1674-490X.2022.03.006

摘要/Abstract

摘要： 视网膜静脉阻塞是在临床上最常见的视网膜血管病,也是常见的致盲眼病之一,发病率随年龄增大而升高,大部分患者65岁以上,但因中国人生活饮食习惯的变化,该病的发病年龄也正在年轻化。黄斑水肿常常合并视网膜静脉阻塞同时出现,也是导致罹患该病患者视力下降的主要原因。对于这种疾病的治疗,有很多方法,每种方法的治疗因患者个体差异而呈现出不同的效果。目前临床上多依据患者自身状况而制定不同的治疗方案,并且多以几种治疗方法联合应用居多。作者通过查阅相关文献及个人在接诊患者过程中不同治疗方案的临床疗效体验,将罹患此病患者的诊疗方案、治疗效果、疾病预后及治疗费用等进行总结与展望,便于发现潜在问题与影响因素,探索最优临床治疗方法。

关键词: 视网膜静脉栓塞, 黄斑水肿, 治疗方法, 效果, 展望

Abstract: Retinal vein occlusion(RVO)is the most common retinal vascular disease and one of the most common causes of blindness. The incidence of RVO increases with age. Most patients are over 65 years old, but the age of onset of the disease is also getting younger because of changes in the Chinese diet. Macular edema, often accompanied by retinal vein occlusion, is also a major cause of vision loss in patients with the disease.At present, there are many treating approaches for the patients with retinal vein occlusion combined with macular edema. Each method has its different effects due to the individual differences of the patients. To date, different treatment schemes are conducted according to the patients' own conditions, and most of them are combined with several treatment methods. By consulting relevant literatures and personal experience in the process of treating patients, the author summarizes and discusses the prospects of the treatment methods, curative effects, prognosis and costs of retinal vein occlusion complicated with macular edema, so as to find potential problems and influencing factors and explore the best clinical treatment regimen.

Key words: retinal vein embolism, macular edema, treatment methods, effect, prospect

中图分类号:

郝建章, 张虎. 视网膜静脉阻塞合并黄斑水肿的治疗与展望[J]. 医学研究与教育, 2022, 39(3): 35-40.

HAO Jianzhang, ZHANG Hu. Prospect of treatment of retinal vein edema combined with macular edema[J]. Journal of Hebei Medical College for Continuing Education, 2022, 39(3): 35-40.

参考文献

[1] 陆秉文, 吴星伟. 视网膜静脉阻塞继发黄斑水肿的治疗进展[J]. 中华眼底病杂志, 2013, 29(6): 640-644.
[2] 褚梦琪. 视网膜静脉阻塞继发黄斑水肿的最新治疗进展[J]. 中华实验眼科杂志, 2018, 36(1): 65-69. DOI: 10.3760/cma.j.issn.2095-0160.2018.01.014.
[3] 李晓宇, 谢立科, 郝晓凤, 等. 中医药治疗视网膜静脉阻塞研究进展[J]. 中国中医基础医学杂志, 2020, 26(1): 140-142.
[4] 马宏杰, 王家良. 复方血栓通胶囊治疗视网膜静脉阻塞继发黄斑水肿及对眼血流动力学的影响[J]. 吉林中医药, 2018, 38(9): 1042-1046. DOI: 10.13463/j.cnki.jlzyy.2018.09.015.
[5] 胡静. 视网膜静脉阻塞血栓形成的防治及护理[J]. 血栓与止血学, 2017, 23(3): 512-514. DOI: 10.3969/j.issn.1009-6213.2017.03.052.
[6] 相自越, 罗向霞, 王虹强, 等. 血栓通离子导入联合康柏西普玻璃体腔注射治疗视网膜静脉阻塞合并黄斑水肿[J]. 国际眼科杂志, 2021, 21(12): 2150-2155. DOI: 10.3980/j.issn.1672-5123.2021.12.25.
[7] 吴虎强, 张安婷, 王楠楠, 等. 刘楚玉教授运用养血活血、通络利水法论治视网膜静脉阻塞性黄斑水肿的经验[J]. 中国中医急症, 2018, 27(8): 1476-1478. DOI: 10.3969/j.issn.1004-745X.2018.08.050.
[8] 勾晓梅, 李雪丽, 隋源, 等. 葛芪复明Ⅳ号联合抗VEGF治疗视网膜静脉阻塞并发黄斑水肿临床疗效观察[J]. 中医药信息, 2019, 36(2): 85-87. DOI: 10.19656/j.cnki.1002-2406.190053.
[9] 伍瑜婕, 陈国孝. 中药联合雷珠单抗玻璃体腔注射治疗视网膜静脉阻塞并发黄斑水肿31例[J]. 浙江中医杂志, 2019, 54(5): 343. DOI: 10.13633/j.cnki.zjtcm.2019.05.027.
[10] 胥静, 吴烈. 视网膜静脉阻塞黄斑水肿的发病机制及治疗进展[J]. 现代中医临床, 2018, 25(2): 50-54. DOI: 10.3969/j.issn.2095-6606.2018.02.014.
[11] 高荔姗, 钟舒阳, 郝小波, 等. 视网膜静脉阻塞黄斑水肿的中西医治疗进展[J]. 广西中医药大学学报, 2019, 22(4): 71-74. DOI: 10.3969/j.issn.2095-4441.2019.04.024.
[12] 冯亚兰, 吴星伟. 灵杞黄斑颗粒治疗不伴黄斑水肿的缺血型RVO的疗效观察[J]. 中国中医眼科杂志, 2018, 28(3): 150-154. DOI: 10.13444/j.cnki.zgzyykzz.2018.03.006.
[13] 刘洪安, 李若溪. 和血明目片治疗视网膜静脉阻塞性眼底出血的临床疗效[J]. 中国药物经济学, 2018, 13(7): 80-82. DOI: 10.12010/j.issn.1673-5846.2018.07.026.
[14] 彭立, 张小花, 劳娜, 等. 康柏西普与雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿的Meta分析[J]. 国际眼科杂志, 2020, 20(3): 455-463. DOI: 10.3980/j.issn.1672-5123.2020.3.11.
[15] 陈露, 李明新. 玻璃体内注射雷珠单抗与康柏西普对视网膜静脉阻塞继发黄斑囊样水肿的疗效比较[J]. 中国眼耳鼻喉科杂志, 2019, 19(1): 26-30. DOI: 10.14166/j.issn.1671-2420.2019.01.010.
[16] 庄靖玲. 和血明目片结合雷珠单抗治疗视网膜静脉阻塞合并黄斑水肿临床疗效及安全性研究[J]. 中华中医药学刊, 2021, 39(7): 172-175. DOI: 10.13193/j.issn.1673-7717.2021.07.043.
[17] 张丽梅. 抗VEGF联合激光在视网膜静脉阻塞合并黄斑水肿中的应用分析[J]. 甘肃科技, 2021, 37(7): 155-157, 166. DOI: 10.3969/j.issn.1000-0952.2021.07.047.
[18] 林琳, 盛艳娟, 王玉. 糖尿病性黄斑水肿的治疗进展[J]. 中华实验眼科杂志, 2013, 31(10): 992-996.
[19] 岳军. 曲安奈德不同给药方式联合倍频532nm激光治疗视网膜静脉阻塞黄斑水肿的疗效比较[J]. 武汉大学学报(医学版), 2014, 35(5): 716-719. DOI: 10.14188/j.1671-8852.2014.05.056.
[20] 黄厚斌, 张卯年. 抗VEGF药物治疗视网膜静脉阻塞黄斑水肿的疗效及安全性评价[J]. 眼科新进展, 2013, 33(1): 1-4. DOI: 10.13389/j.cnki.rao.2013.01.002.
[21] MOISSEIEV E, GOLDSTEIN M, WAISBOURD M, et al. Long-term evaluation of patients treated with dexamethasone intravitreal implant for macular edema due to retinal vein occlusion[J]. Eye(Lond), 2013, 27(1): 65-71. DOI: 10.1038/eye.2012.226.
[22] SINGER M A, COHEN S R, GROTH S L, et al. Comparing bevacizumab and ranibizumab for initial reduction of central macular thickness in patients with retinal vein occlusions[J]. Clin Ophthalmol, 2013, 7: 1377-1383. DOI: 10.2147/OPTH.S46235.
[23] 赵堪兴, 杨培增. 眼科学[M]. 8版. 北京: 人民卫生出版社, 2013: 213-214.
[24] ASHRAF M, KAYAL H E, SOUKA A A R. Safety and efficacy of ziv-aflibercept in the treatment of refractory diabetic macular edema[J]. Ophthalmic Surg Lasers Imaging Retina, 2017, 48(5): 399-405. DOI: 10.3928/23258160-20170428-06.
[25] 杨瑞芳, 杜红艳. 视网膜静脉阻塞治疗新进展[J]. 国际眼科杂志, 2016, 16(9): 1655-1660. DOI:10.3980/j.issn.1672-5123.2016.9.14.
[26] JUNG S H, KIM K A, SOHN S W, et al. Association of aqueous humor cytokines with the development of retinal ischemia and recurrent macular edema in retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2014, 55(4): 2290-2296. DOI: 10.1167/iovs.13-13587.
[27] 魏丽丽, 冼文光. 康柏西普联合激光治疗视网膜分支静脉阻塞合并的黄斑囊性水肿的临床疗效[J]. 武汉大学学报(医学版), 2016, 37(1): 149-151, 157. DOI: 10.14188/j.1671-8852.2016.01.034.
[28] 黄翠, 李进. 康柏西普联合激光光凝治疗视网膜静脉阻塞合并黄斑水肿的临床效果及对视力水平的影响[J]. 实用老年医学, 2020, 34(4): 377-380. DOI: 10.3969/j.issn.1003-9198.2020.04.018.