Retinal vein occlusion
小结
定义
病史和体格检查
关键诊断因素
- sudden, painless vision loss
- optic nerve head edema
- intraretinal hemorrhage
- venous tortuosity and dilation
- collateral vessel formation
其他诊断因素
- age >65 years
- neovascularization
- vitreous hemorrhage
- macular edema
- floaters
- painful, red eye
- visual acuity
- relative afferent pupillary defect
- elevated intraocular pressure
危险因素
- atherosclerosis
- systemic hypertension
- diabetes mellitus
- hyperlipidemia
- history of smoking
- cardiovascular disease
- glaucoma
- increased body mass index at 20 years of age
- increased serum alpha-2 globulin
- short axial length
- age >65 years
- activated protein C resistance
- factor V Leiden
- hypercoagulable state
- protein S deficiency
- antithrombin III deficiency
- hyperhomocysteinemia
- vasculitis
诊断性检查
首要检查
- fluorescein angiogram for confirmation of diagnosis
需考虑的检查
- fluorescein angiogram for assessment of complications
- optical coherence tomography
- electroretinography
治疗流程
CRVO: uncomplicated
CRVO with macular edema
CRVO with neovascularization
BRVO or HRVO: uncomplicated
BRVO or HRVO with macular edema
BRVO or HRVO with neovascularization
撰稿人
作者
Aziz A. Khanifar, MD
Vitreoretinal Surgeon
The Retina Group of Washington
Silver Spring
MD
利益声明
AAK has been a speaker for Genentech and Regeneron.
鸣谢
Dr Aziz A. Khanifar would like to gratefully acknowledge Dr Sharon Fekrat, a previous contributor to this topic.
利益声明
SF declares that she has no competing interests.
同行评议者
Stephen G. Schwartz, MD
Assistant Professor of Clinical Ophthalmology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine
Naples
FL
利益声明
SGS has received research funding from Alcon, Genentech, and Novartis; holds equity in Pfizer; and is co-holder of a patent pending entitled "Molecular targets for modulating intraocular pressure and differentiation of steroid responders from non-responders".
Tim Murray, MD
Professor of Ophthalmology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine
Naples
FL
利益声明
TM declares that he has no competing interests.
Alexander Spratt, MBBCh, MRCOphth
Specialist Registrar
Moorfields Eye Hospital
Visiting Lecturer
City University
London
UK
利益声明
AS has received research funding from Allergan.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Romano F, Lamanna F, Gabrielle PH, et al. Update on retinal vein occlusion. Asia Pac J Ophthalmol (Phila). 2023 Mar-Apr;12(2):196-210.全文 摘要
The Royal College of Ophthalmologists. Retinal vein occlusion guidelines. Feb 2022 [internet publication].全文
Kovach JL, Bailey ST, Kim SJ, et al. Retinal vein occlusions preferred practice pattern®. Ophthalmology. 2025 Apr;132(4):P303-43.全文
Nicholson L, Talks SJ, Amoaku W, et al. Retinal vein occlusion (RVO) guideline: executive summary. Eye (Lond). 2022 May;36(5):909-12.全文 摘要
Shalchi Z, Mahroo O, Bunce C, et al. Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion. Cochrane Database Syst Rev. 2020 Jul 7;7:CD009510.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Ischemic optic neuropathy
- Retinal detachment (RD)
- Choroidal neovascularization (CNV)
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