专家带路 | 四大专家告诉你关于视网膜静脉阻塞治疗的新方法

时间:2019-07-13 来源: 专栏

Fundus diseases have always been a problem that plagues the ophthalmology. Retinal vein occlusion (RVO) is still completely controlled without specific treatment. On June 15th, during the 13th Annual Meeting of the Chinese Medical Doctors Association of Ophthalmologists and the Annual Meeting of the Eye Branch of Henan Medical Doctors Association in Zhengzhou, Zhangzhou Pharmaceutical held the topic of thrombus injection for the treatment of retinal vein occlusion. During the session, the forum was chaired by Professor Zhao Mingwei of Peking University People's Hospital and Professor Chen Youxin of Peking Union Medical College Hospital.


Professor Zhao Mingwei

Professor Zhao Mingwei pointed out that Chinese medicine has a certain auxiliary effect in the treatment of ischemic eye disease, and Sanqi saponin has a long history in the prevention and treatment of ischemic eye disease. The application of Xueshuantong for injection (main ingredient Panax notoginseng saponins) has been used for nearly 25 years. As the original research enterprise of Xueshuantong, Zhangzhou Pharmaceutical has paid attention to academics in recent years, paying attention to standardized Chinese and Western medicine treatment, and helping traditional medicine to make ophthalmology development. Should contribute.


Professor Lu Fang

Professor Lu Fang, deputy director of the Eye Branch of Sichuan Medical Association and Professor Lu Fang of Huaxi Hospital, said that RVO is a common fundus disease in the elderly. Many patients have good effects after anti-VEGF drug therapy or hormone therapy, but the recurrence problem is a difficult problem in the clinic. Is the combination of short-term, flat, and fast characteristics of Western medicine and Chinese medicine treatment more beneficial to patients? Some patients in the clinic have achieved good results after receiving Western medicine and traditional Chinese medicine injection with Xueshuantong (freeze-dried). Professor Lu Fang said that Chinese medicine can effectively prevent macular edema, and its role in the treatment of RVO can not be ignored, and the potential is huge.


Professor Yue Lijing

xxProfessor Yue Lijing, president of the Guangdong Eye Health Association and director of the Department of Ophthalmology of the Second Hospital of Guangdong Province, pointed out that the incidence of RVO is second only to diabetic retinopathy, and RVO and its associated diseases bring a heavy disease burden to patients. At present, RVO has no specific drugs, and it is commonly used in medicines such as glucocorticoids, anti-VEGF drugs and thrombolytic drugs. These drugs are effective in clinical treatment, but the disadvantages are that they are prone to complications such as high intraocular pressure, glaucoma, cataract, and adverse reactions such as endophthalmitis, vitreous hemorrhage, and retinal detachment. Studies have shown that Panax notoginseng saponins have a three-fold mechanism of improving ocular blood circulation, inhibiting angiogenesis and protecting the optic nerve, and can be used as a new perspective for clinical treatment of RVO.

RVO, also known as retinal stroke, is the second most common type of blinding retinal vasculopathy. Clinical manifestations of retinal blood flow stagnation, venous tortuosity, retinal hemorrhage and edema. RVO can cause a variety of complications, such as macular edema, retinal/anterior neovascularization, vitreous hemorrhage. "RVO and its complications have greatly damaged vision. We must try our best to save more vision within the most reasonable time," Professor Lu Fang said.

Risk factors for RVO include cardiovascular factors, metabolic disorders, eye factors and others, but ocular circulatory disorders are an important cause.

Professor Lu pointed out that the purpose of RVO treatment is to prevent visual damage caused by macular edema as much as possible. In addition to targeted treatment, it is also necessary to actively treat systemic diseases. At present, there is no uniform treatment standard for RVO in China.

xxThe 2015 UK RVO Clinical Guidelines recommend that non-ischemic CRVO be selected for anti-VEGF drugs or intraocular hormones depending on vision. Ischemic CRVO, iris/atrial angiogenesis, anterior chamber angle open, emergency PRP; anterior chamber angle closure for emergency PRP + laser treatment/lead (the latter is preferred); no iris/angle Neovascularization, FFA>DA without perfusion, prophylactic PRP. The treatment of ischemic CRVO macular edema is the same as non-ischemic CRVO. The treatment of BRVO is similar to that of CRVO, and if the ischemic BRVO develops neovascularization, local laser photocoagulation in the ischemic quadrant is also considered.

The 2015 Canadian RVO Expert Consensus is similar to the UK Guide, but the evaluation system adds OCT to assess the extent of macular edema.

American AAO guidelines, BRVO patients with macular edema, the initial treatment of anti-VEGF drugs. CRVO with macular edema, anti-VEGF drug is effective, strongly recommended. Intravitreal injection of triamcinolone acetonide, dexamethasone and other glucocorticoids is effective, but there is a risk of cataracts and glaucoma.

CRVO iris or retinal neovascularization, the best treatment is panretinal photocoagulation (PRP), such as PRP is not enough to control neovascularization, consider combined anti-VEGF drugs.

Professor Lu Fang said that many RVO patients have good effects after anti-VEGF drug therapy or hormone therapy, but the recurrence problem is very common after three or four months, and edema and hemorrhage are more serious after recurrence, which is a difficult problem in the clinic. She found in the clinic that some patients did receive good results after receiving Western medicine and traditional Chinese medicine injection of Xueshuantong (main ingredient Panax notoginseng saponins).

xx文献表明,三七总皂苷在四个方面起主要治疗作用:(1)抗凝:抑制纤维蛋白原向纤维蛋白的转化。 (2)血管扩张:阻断去甲肾上腺素引起的细胞外钙离子流动,从而放松血管平滑肌。 (3)降低血液粘稠度。 (4)视神经保护:具有直接和间接的抗炎作用,对视神经损伤起保护作用。




岳丽静教授表示,RVO的总患病率为1.3%,BRVO的患病率为1.2%,CRVO的患病率为0.1%。 RVO 37%与黄斑水肿(ME)相关,BRVO 30%与ME结合,CRVO 71%与ME结合。岳丽静教授介绍,无论是什么并发症,RVO都有低视力和失明的高发病率,眼循环障碍是一个重要原因。眼底血液循环障碍主要表现为血管外压迫,静脉淤滞和静脉血管壁损伤三个方面,RVO与新生血管形成,黄斑水肿形成和视神经损伤有关。


三七总皂苷的主要成分是清楚的,抑制由多种激动剂引起的血小板聚集。人参皂苷Rg1抑制血小板活化并防止血栓形成;人参皂甙Rg1/Rb1/resaerythritol R1在炎症过程中显着降低白细胞与血管内皮的粘附;人参皂苷Rb1能有效抑制视网膜色素上皮细胞分泌VEGF,抑制缺氧和氧化应激状态下视网膜神经节细胞凋亡,保护视神经。









Professor Chen Youxin: "Chinese medicine can cure diseases, but often do not know how to treat diseases. We hope to know why through scientific research. These studies introduced by Professor Yue show that the use of thrombus injection for the treatment of RVO is clinically effective, theoretically explained Western medicine should not contravene traditional Chinese medicine. Artemisinin, which was awarded the Nobel Prize by Professor Tu Yu, was extracted from the Chinese medicine Daqingye. Researching traditional Chinese medicine through scientific and modern methods is waiting for everyone to work together."

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