Etiopatogeneza i liječenje tromboze centralne retinalne vene

master's thesis

• Title (english): Etiopathogenesis and treatment of central retinal vein thrombosis
• Author: Ena Sušić
• Mentor: Tomislav Jukić (mentor)
• Committee member: Damir Katušić (predsjednik povjerenstva)
• Committee member: Miro Kalauz (član povjerenstva)
• Committee member: Tomislav Jukić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Ophthalmology and Optometry); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Ophthalmology

Abstract

Okluzija centralne retinalne vene i njezinih ogranaka uzrokovana je lokalnom trombozom na mjestu gdje sklerotična arterija pritišće venu. Bolest počinje naglim gubitkom vida na zahvaćenom oku. Okluzija centralne retinalne vene je čest uzrok gubitka vida u starijih pojedinaca te, poslije dijabetičke retinopatije, druga je po učestalosti retinalna vaskularna bolest. Dijeli se na okluziju grane centralne retinalne vene, okluziju centralne retinalne vene i hemiretinalnu gornju ili donju vensku okluziju. Dalje se dijeli u dvije kategorije: blažu neishemijsku i težu ishemijsku. Ishemijsko oštećenje retine stimulira povećanu proizvodnju vaskularnog endotelnog faktora rasta (VEGF) u staklovini koji stimulira neovaskularizaciju posteriornog i anteriornog segmenta oka koja je zaslužna za sekundarne komplikacije. Incidencija se povećava s dobi i kreće se od 0,5% do 4,6% kod pacijenata koji su stariji od 80 godina. Faktori rizika uz dob su hipertenzija, hiperlipidemija i dijabetes. Prezentira se kao naglo, unilateralno zamućenje vida. Dijagnosticira se kompletnim oftalmološkim pregledom, flouresceinskom angiografijom, OCT-om i fundus autofluorescencijom. Još uvijek ne postoji djelotvorni lijek ni za prevenciju ni za liječenje okluzije centralne retinalne vene. Od medikamenata daju se intravitrealno humanizirana VEGF antitijela koja se vežu i neutraliziraju sve izoforme VEGF-a (ranimizumab, aflibercept, bevacizumab), zatim intravitrealni kortikosteroidi (triamcinolon, deksametazon). Od kirurških metoda rabe se laserska fotokoagulacija, korioretinalna venska anostomoza, vitrektomija i radijalna optička neurotomija s neizvjesnim kliničkim ishodom. U zaključku valja istaknuti da je najvažnije djelovati na faktore rizika na koje se može utjecati.

Abstract (english)

Occlusion of the central retinal vein and its branches is caused by local thrombosis at the site where sclerotic arteries press the vein. The disease begins with a sudden loss of vision in the affected eye. Occlusion of the central retinal vein is a common cause of vision loss in older individuals and, after the diabetic retinopathy, is the second most common retinal vascular disease. It is divided into branch retinal vein occlusion, central retinal vein occlusion and hemiretinal upper or lower vein occlusion. It is subdivided into two categories: less severe non-ischemic and severe ischemic. Ischemic damage to the retina stimulates increased production of vascular endothelial growth factor (VEGF) in the vitreous stimulating neovascularization of the anterior and posterior segment of the eye that is responsible for secondary complications. The incidence increases with the age, ranging from 0.5% to 4.6% in patients who are older than 80. Risk factors, except age, are hypertension, hyperlipidemia and diabetes. It presents as a sudden, unilateral blurred vision. It is diagnosed by a complete ophthalmologic examination, fluorescein angiography, by OCT and fundus autofluorescence. There is still no effective cure either for the prevention or for the treatment of central retinal vein occlusion. Medicaments that are used are intravitreally administered VEGF humanized antibodies that bind and neutralize all the isoforms of VEGF (ranimizumab, aflibercept, bevacizumab), then intravitreal corticosteroids (triamcinolone, dexamethasone). Surgical methods that are used are laser photocoagulation, chorioretinal venous anastomosis, vitrectomy and radial optic neurotomy with unknown clinical outcomes. In conclusion, the most important thing is to act on the risk factors which can be affected.

• Keywords: okluzija centralne retinalne vene; VEGF; anti-VEGF
• Keywords (english): central retinal vein occlusion; VEGF; anti-VEGF
• Language: croatian
• URN:NBN: urn:nbn:hr:105:948582
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-19 11:30:49