关于视网膜静脉阻塞继发黄斑水肿相关性分析

Correlation Analysis of Macular Edema Secondary to Retinal Vein Occlusion

摘要: 阻塞是眼科疾病中造成视网膜血管损害的主要原因之一，通常根据特定静脉闭塞的位置将RVO分为三个主要亚组，即中央静脉阻塞，半中心静脉阻塞和分支静脉阻塞。视网膜静脉阻塞由于血栓形成的堵塞而引起的，可使视网膜中央静脉、半中央或分支静脉受到累及。邻近的视网膜动脉粥样硬化所导致的压迫，是RVO最常见的病因。其它可能是由于血管炎等外在的压迫或静脉壁病所致。有研究对亚洲裔和西班牙裔人视野扩瞳眼底照相检查进行研究汇总分析，表明与白人群相比，亚洲裔和西班牙裔人群患分支视网膜静脉阻塞(Branch retinal vein occlusion, BRVO)的风险更高，而不同种族在中央视网膜静脉阻塞(Central retinal vein occlusion, CRVO)发病率方面未见显著差异。BRVO的主要危险因素包括全身性动脉高血压、动脉硬化和糖尿病，包括血栓形成。局部解剖变异可能在所有类型静脉闭塞的形成中发挥作用，但BRVO最常见的是由于动静脉交叉部位增厚的小动脉压迫静脉。相反，CRVO由于病灶累及视神经头内而发病机制更加复杂。中枢性RVO更可能与青光眼、睡眠呼吸暂停相关，而与血栓形成的相关性并不常见，尤其是在年轻患者中。本文旨在了解RVO-ME的发病机制和预后相关因素，有助于临床早期识别高危病人，制定个体化的治疗方案，设置合理的预后预期，加强病人的教育和随访管理，最终目的是使病人的视力功能得到最大程度的挽救和提高。

Abstract: Obstruction is one of the main causes of retinal vascular damage in ophthalmic diseases. RVO is usually classified into three main subgroups based on the location of specific vein occlusion, namely central retinal vein occlusion, hemi-central retinal vein occlusion, and branch retinal vein occlusion. RVO is caused by thrombosis and can affect the central retinal vein, hemi-central vein, or branch vein. The most common cause of RVO is compression due to atherosclerosis of adjacent retinal arteries. Other possible causes include external compression or venous wall disease such as vasculitis. A study that summarized and analyzed the results of dilated fundus photography in Asian and Hispanic individuals showed that the risk of branch retinal vein occlusion (BRVO) was higher in Asian and Hispanic populations compared to the white population, while there was no significant difference in the incidence of central retinal vein occlusion (CRVO) among different races. The main risk factors for BRVO include systemic arterial hypertension, arteriosclerosis, and diabetes, including thrombosis. Local anatomical variations may play a role in the formation of all types of vein occlusion, but BRVO is most commonly caused by compression of the vein by thickened small arteries at the arteriovenous crossing. In contrast, the pathogenesis of CRVO is more complex due to the involvement of the optic disc. Central RVO is more likely to be associated with glaucoma and sleep apnea, and the association with thrombosis is less common, especially in younger patients. The purpose of this article is to understand the pathogenesis and prognostic factors of RVO-ME, which will help in the early identification of high-risk patients in clinical practice, the formulation of individualized treatment plans, the setting of reasonable prognosis expectations, and the strengthening of patient education and follow-up management. The ultimate goal is to maximize the preservation and improvement of patients’ visual function.