国际眼科纵览

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家族性渗出性玻璃体视网膜病变的临床管理策略

严宏祥 张自峰 李曼红 王雨生   

  1. 空军军医大学西京医院眼科 全军眼科研究所,西安 710032
  • 收稿日期:2020-03-28 出版日期:2020-08-22 发布日期:2020-09-01
  • 通讯作者: 张自峰,Email:zzffmmu@163.com E-mail:zzffmmu@163.com
  • 基金资助:
    国家自然科学基金(81770936);陕西省重点研发计划(2017SF-222);西京医院学科助推计划(XJZT18ML21)

Clinical management strategies for familial exudative vitreoretinopathy

Yan Hongxiang, Zhang Zifeng, Li Manhong, Wang Yusheng   

  1. Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
  • Received:2020-03-28 Online:2020-08-22 Published:2020-09-01
  • Contact: Zhang Zifeng, Email: zzffmmu@163.com E-mail:zzffmmu@163.com
  • Supported by:
    National Natural Science Foundation of China (81770936); Key Research and Development Program of Shaanxi Province (2017SF-222); Discipline Promotion Program of Xijing Hospital (XJZT18ML21)

摘要: 家族性渗出性玻璃体视网膜病变(familial exudative vitreoretinopathy,FEVR)是一种较为罕见的遗传性血管发育不良所致的玻璃体视网膜疾病,是导致30岁以下人群视力损害甚至失明的重要原因之一。本病临床异质性大,具有终身不可预知性进展的特征,早期可无明显的临床表现,但随着病情进展,会出现周边视网膜无血管区、视网膜渗出、新生血管形成、视网膜皱襞、黄斑移位、视网膜脱离甚至失明等表现。结合眼部表现及广域眼底血管造影检查对患者病情进展进行临床分期,并制定科学合理的临床管理策略,做好疾病的早期识别、定期随访以及遗传咨询。早期病变采用激光光凝、冷冻治疗以及抗血管内皮生长因子治疗控制渗出及新生血管;晚期病变可通过巩膜扣带术和玻璃体手术避免不良预后;同时也应重视儿童及青少年FEVR患者的视觉功能训练以及心理康复干预。从而达到阻止或稳定疾病进展,保存视功能,进一步改善生存质量的目的。

Abstract: Familial exudative vitreoretinopathy (FEVR), a rare hereditary vitreoretinal abnormality, characterized by insufficient vascular development is a leading cause of visual impairment and even blindness in people under 30 years old. It is a lifelong disease with obvious clinical heterogeneity and unpredictable progression. Although significant presentations may not occur in the early stages, the characteristic clinical features show up with progression, which includes avascular peripheral retina, subretinal exudation, peripheral retinal neovascularization, retinal fold, macular dragging, and even retinal detachment resulting in blindness finally. In order to prevent or stabilize the disease, preserve visual function, and further improve the quality of life, it is of significance to pay close attention to identifying clinical stages of FEVR according to ocular manifestations and wide-field angiography, and developing appropriate clinical management strategies. Early identification, regular follow-up and genetic counseling should be performed in clinical practice. Photocoagulation, cryotherapy and anti-vascular endothelial growth factor therapy can be applied in early stage to control exudation and neovascularization. Scleral buckling and vitrectomy can be used in late stage to prevent unfavourable prognosis. In addition, for pediatric and adolescent patients with FEVR, it is indispensable of functional vision training and psychological rehabilitation as well .