今日の臨床サポート

視力低下

著者: 高木均 聖マリアンナ医科大学病院 

監修: 沖波聡 倉敷中央病院眼科

著者校正/監修レビュー済:2022/04/27
参考ガイドライン:
  1. 日本糖尿病眼学会:糖尿病網膜症診療ガイドライン(第1版)
  1. 日本眼炎症学会:ぶどう膜炎診療ガイドライン
患者向け説明資料

概要・推奨   

  1. 網膜格子状変性や無症候性の網膜裂孔への光凝固は網膜剝離の予防処置として積極的に行うことはおそらく推奨されない(推奨度2)
  1. 糖尿病網膜症は前増殖網膜症になるまでは年に1回、前増殖網膜症になると年に3回程度定期検査を行う必要がある。
  1. 2型糖尿病患者では重症非増殖網膜症のときに汎網膜光凝固を行う。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
高木均 : 研究費・助成金など(バイエル薬品(株)),奨学(奨励)寄付など(医療法人ひまわり会,バイエル薬品(株),参天製薬(株),千寿製薬(株))[2022年]
監修:沖波聡 : 特に申告事項無し[2022年]

改訂のポイント:
  1. 定期レビューを行い、加筆・修正を行った。

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 視力低下を起こす疾患は角膜疾患・前部ぶどう膜炎・急性緑内障などの前眼部疾患から、白内障・硝子体混濁など中間透光体の疾患、網脈絡膜疾患・視神経疾患・外傷など多岐にわたる。多くの疾患において適切な治療を早期に開始することが視機能の保持に不可欠であり、ワークアップにより原因疾患を同定し適切な治療を開始する必要がある。
  1. 視力低下には、両眼性と片眼性、急激に起こる場合と緩徐に進行する場合があり、問診により鑑別する。
  1. 矯正視力検査は屈折異常を見極めるために有効である。
  1. 瞳孔反応にて相対性瞳孔求心路障害をみることで左右差のある視入力障害があることが見いだせる。
  1. 細隙灯顕微鏡検査により、前眼部疾患の有無、中間透光体混濁の有無、眼底検査により眼底疾患、視神経疾患を同定する。
  1. 両眼性視力低下ではぶどう膜炎、真菌性眼内炎、糖尿病網膜症、腎性網膜炎、薬物中毒、妊娠中毒症などの全身疾患に由来するもの、頭蓋内病変、視神経炎や、急性後部多発性斑状色素上皮症(APMPPE)など両眼性に発症する眼底疾患を想定する。
問診・診察のポイント  
  1. 視力低下の原因は多岐にわたるが、屈折異常を除き、できるだけ早急に眼科に紹介する。

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文献 

L A Levin, R W Beck, M P Joseph, S Seiff, R Kraker
The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study.
Ophthalmology. 1999 Jul;106(7):1268-77.
Abstract/Text OBJECTIVE: To compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment.
DESIGN: Comparative nonrandomized interventional study with concurrent treatment groups.
PARTICIPANTS: A total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis.
INTERVENTIONS: On the basis of treatment received within 7 days of injury, patients with unilateral injuries were categorized as being in one of three treatment groups: untreated (n = 9), corticosteroid (n = 85), or optic canal decompression surgery (n = 33).
MAIN OUTCOME MEASURE: Visual acuity.
RESULTS: Visual acuity increased by > or = 3 lines in 32% of the surgery group, 57% of the untreated group, and 52% of the steroid group (P = 0.22). The surgery group had more patients whose initial vision was no light perception. After adjustment for the baseline visual acuity, there were no significant differences between any of the treatment groups. There was no indication that the dosage or timing of corticosteroid treatment or the timing of surgery was associated with an increased probability of visual improvement.
CONCLUSIONS: No clear benefit was found for either corticosteroid therapy or optic canal decompression surgery. The number of patients studied was sufficient to rule out major effects in the treatment groups, although clinically relevant effects in specific subgroups could have been missed. These results and the existing literature provide sufficient evidence to conclude that neither corticosteroids nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy. It is therefore clinically reasonable to decide to treat or not treat on an individual patient basis.

PMID 10406604
R W Beck, P A Cleary, M M Anderson, J L Keltner, W T Shults, D I Kaufman, E G Buckley, J J Corbett, M J Kupersmith, N R Miller
A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.
N Engl J Med. 1992 Feb 27;326(9):581-8. doi: 10.1056/NEJM199202273260901.
Abstract/Text BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period.
RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95).
CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

PMID 1734247
J S Minkowski, M Palese, D L Guyton
Potential acuity meter using a minute aerial pinhole aperture.
Ophthalmology. 1983 Nov;90(11):1360-8.
Abstract/Text A new instrument allows accurate measurement of retinal visual acuity behind mild to moderate cataracts. Mounted on a slit lamp, the Potential Acuity Meter projects a Snellen visual acuity chart into the eye via a narrow beam of light converging to a minute aerial aperture only 0.15 mm in diameter. The examiner aims the narrow beam through "windows" in the cataract, avoiding blockage or scattering of the light that would otherwise occur. In 47 cataractous eyes having best preoperative visual acuity of 20/200 and better, the postoperative visual acuity was predicted to within three lines in 100% of cases, and to within two lines in 91%. With a successful result from cataract surgery defined as postoperative vision of 20/40 or better, the prediction of success with the Potential Acuity Meter was correct in 95% of cases.

PMID 6664676
A Rodriguez, M Calonge, M Pedroza-Seres, Y A Akova, E M Messmer, D J D'Amico, C S Foster
Referral patterns of uveitis in a tertiary eye care center.
Arch Ophthalmol. 1996 May;114(5):593-9.
Abstract/Text OBJECTIVE: To analyze the referral patterns and diagnosis of uveitis during the past decade in a large tertiary eye center.
DESIGN: The records of 1237 patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary from 1982 to 1992 were classified and analyzed. Data regarding sex, race, nationality, referral site, ages at presentation and onset of uveitis, ocular involvement, clinical characteristics, ocular condition, and systemic disease associations were obtained.
RESULTS: The mean age at onset of uveitis was 37.2 years; the male-to-female ratio was 1:1.4. Most patients were white (85.8%), born in the United States (83.1%), and referred from within New England (84.7%). Anterior uveitis was most common (51.6%), followed by posterior uveitis (19.4%), panuveitis (16.0%), and intermediate uveitis (13.0%). Chronic (58.3%), nongranulomatous (77.7%), and noninfectious (83.1%) were the most frequent types of uveitis. The most common entities included idiopathic (34.9%), seronegative spondyloarthropathies (10.4%), sarcoidosis (9.6%), juvenile rheumatoid arthritis (5.6%), systemic lupus erythematosus (4.8%), Behçet's disease (2.5%), and the acquired immunodeficiency syndrome (2.4%).
CONCLUSION: The appearance of new uveitic entities, such as the acute retinal necrosis syndrome, multifocal choroiditis and panuveitis, birdshot retinochoroidopathy, and acquired immunodeficiency syndrome-related uveitis, and the reemergence of the classic infectious causes of uveitis, tuberculosis and syphilis, have changed the way we approach the diagnosis and management of posterior and panuveitis at the Massachusetts Eye and Ear Infirmary.

PMID 8619771
W J Power, A Rodriguez, M Pedroza-Seres, C S Foster
Outcomes in anterior uveitis associated with the HLA-B27 haplotype.
Ophthalmology. 1998 Sep;105(9):1646-51. doi: 10.1016/S0161-6420(98)99033-9.
Abstract/Text OBJECTIVE: This study aimed to test the hypothesis that patients presenting with anterior uveitis who are HLA-B27 positive, either with or without associated systemic disease, have a less-favorable outcome than do patients with idiopathic anterior uveitis who are HLA-B27 negative.
DESIGN: Retrospective case-controlled series.
PARTICIPANTS: Ninety-seven patients who were HLA-B27 positive with no systemic disease, 94 patients who were HLA-B27 positive with systemic disease, and 72 patients who were HLA-B27 negative who presented with anterior uveitis were studied.
MAIN OUTCOME MEASURES: Ocular complications (e.g., secondary glaucoma, cataract formation, pupillary synechiae, vitritis, cystoid macular edema, and optic disc edema), medical and surgical treatment, number of recurrent attacks, and final visual acuity were recorded for all patients.
RESULTS: The patients who were HLA-B27 positive, either with or without systemic disease, experienced a greater number of complications than did the patients who were HLA-B27 negative. Periocular corticosteroids, systemic corticosteroids, and systemic immunosuppressive chemotherapy were required in a far greater number of HLA-B27-positive patients than in HLA-B27-negative patients (60% vs. 11%, 53% vs. 7%, and 18% vs. 1%, respectively; P < 0.001). The percentage of legally blind eyes was significantly greater in the HLA-B27-positive group, both with and without systemic disease, when compared with the HLA-B27-negative group (11% vs. 2%; P < 0.005).
CONCLUSIONS: The prognosis of anterior uveitis associated with the HLA-B27 haplotype, either with or without associated systemic disease, is less favorable when compared with that of HLA-B27-negative patients with idiopathic anterior uveitis.

PMID 9754172
N E Byer
Long-term natural history of lattice degeneration of the retina.
Ophthalmology. 1989 Sep;96(9):1396-401; discussion 1401-2.
Abstract/Text An initial series of patients with lattice degeneration was reported to the Academy in 1964 and a follow-up report given in 1973. A continuing prospective study of 276 consecutive untreated patients (423 eyes) is now reported with follow-up from 1 to 25 years (average, 10.8 years). Clinical retinal detachments (RDs) occurred in 3 (1.08%) of 276 patients and 0.7% of eyes. Tractional retinal tears were seen in eight (2.9%) patients and 1.9% of eyes; one of these led to a clinical RD. Clinical or progressive subclinical RD occurred in 3 (2%) of eyes with atrophic holes. Subclinical RD was seen in 10 (6.7%) of 150 eyes with atrophic holes, involving 9 (7.5%) of 120 patients, and had a much less serious prognosis than clinical detachment. Prophylactic treatment of lattice with or without holes in phakic, nonfellow eyes should be discontinued.

PMID 2780007
Abstract/Text PURPOSE: To assess the quality of information in the literature regarding the benefits of prophylactic treatment of asymptomatic retinal tears and lattice degeneration.
CLINICAL RELEVANCE: Asymptomatic retinal breaks occur in approximately 7% of patients over age 40, and lattice degeneration is present in approximately 8% of the general population. Because retinal breaks cause retinal detachment and lattice degeneration is associated with approximately 30% of retinal detachments, prophylactic treatment of these lesions has sometimes been recommended.
LITERATURE REVIEWED: A panel of vitreoretinal experts performed a literature review of all publications regarding prevention of retinal detachment that have been published in English. These articles were then used to prepare recommendations for patient care in an American Academy of Ophthalmology Preferred Practice Pattern (PPP). Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation.
RESULTS: Most recommendations were rated as A (most important to patient care). Only a single publication was graded as I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of level I and level II studies in the literature, level III (consensus of expert opinion) was the basis for most recommendations in the PPP.
CONCLUSIONS: The current literature regarding prevention of retinal detachment does not provide sufficient information to support strongly prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.

PMID 10647712
Lloyd M Aiello
Perspectives on diabetic retinopathy.
Am J Ophthalmol. 2003 Jul;136(1):122-35.
Abstract/Text PURPOSE: To review the evolution of the understanding of diabetic retinopathy (DR) and methods of treating DR, the present clinically relevant practice for eye disease in patients with diabetes mellitus, and trends in clinical patient care over the next 3 to 5 years.
DESIGN: Tabular review and presentation of clinical trials contributing to the understanding and treatment of DR and the author's philosophy of care for the patient with diabetes.
RESULTS: Diabetic retinopathy is a microvascular complication of diabetes mellitus that is a significant cause of new-onset blindness. The Diabetic Retinopathy Study was the first multicentered, randomized, clinical trial in ophthalmology. This study provided the scientific evidence for treatment of DR with scatter (panretinal) photocoagulation, and led to the funding of other multicentered clinical trials, including the Early Treatment Diabetic Retinopathy Study, which greatly elucidated the natural history of DR and firmly established laser photocoagulation as treatment for proliferative diabetic retinopathy (PDR) and diabetic macular edema. The Diabetes Control and Complications Trial and United Kingdom Prospective Diabetes Study established the value of intensive glycemic control in reducing the risk of onset and progression of DR and other microvascular complications of diabetes.
CONCLUSIONS: Severe vision loss and moderate vision loss from diabetes are essentially preventable with timely detection and treatments, careful long-term follow-up and comprehensive diabetes mellitus care firmly based on clinical evidence. Future treatments, as outgrowths of further understanding of the biochemical basis of the disease, will aim at curing or preventing retinal complications from diabetes.

PMID 12834680
Abstract/Text Data from the Diabetic Retinopathy Study (DRS) show that photocoagulad inhibited the progression of retinopathy. These beneficial effects were noted to some degree in all those stages of diabetic retinopathy which were included in the Study. Some deleterious effects of treatment were also found, including losses of visual acuity and constriction of peripheral visual field. The risk of these harmful effects was considered acceptable in eyes with retinopathy in the moderate or severe retinopathy in the moderate or severe proliferative stage when the risk of severe visual loss without treatment was great. In early proliferative or severe nonproliferative retinopathy, when the risk of severe visual loss without treatment was less, the risks of harmful treatment effects assumed greater importance. In these earlier stages, DRS findings have not led to a clear choice between prompt treatment and deferral of treatment unless and until progression to a more severe stage occurs.

PMID 345173
Abstract/Text The Early Treatment Diabetic Retinopathy Study (ETDRS) enrolled 3711 patients with mild-to-severe nonproliferative or early proliferative diabetic retinopathy in both eyes. One eye of each patient was assigned randomly to early photocoagulation and the other to deferral of photocoagulation. Follow-up examinations were scheduled at least every 4 months and photocoagulation was initiated in eyes assigned to deferral as soon as high-risk proliferative retinopathy was detected. Eyes selected for early photocoagulation received one of four different combinations of scatter (panretinal) and focal treatment. This early treatment, compared with deferral of photocoagulation, was associated with a small reduction in the incidence of severe visual loss (visual acuity less than 5/200 at two consecutive visits), but 5-year rates were low in both the early treatment and deferral groups (2.6% and 3.7%, respectively). Adverse effects of scatter photocoagulation on visual acuity and visual field also were observed. These adverse effects were most evident in the months immediately following treatment and were less in eyes assigned to less extensive scatter photocoagulation. Provided careful follow-up can be maintained, scatter photocoagulation is not recommended for eyes with mild or moderate nonproliferative diabetic retinopathy. When retinopathy is more severe, scatter photocoagulation should be considered and usually should not be delayed if the eye has reached the high-risk proliferative stage. The ETDRS results demonstrate that, for eyes with macular edema, focal photocoagulation is effective in reducing the risk of moderate visual loss but that scatter photocoagulation is not. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. Focal treatment should be considered for eyes with macular edema that involves or threatens the center of the macula.

PMID 2062512
Abstract/Text BACKGROUND: Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications.
METHODS: A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly.
RESULTS: In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia.
CONCLUSIONS: Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.

PMID 8366922
Abstract/Text BACKGROUND: Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown. There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation. We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial.
METHODS: 3867 newly diagnosed patients with type 2 diabetes, median age 54 years (IQR 48-60 years), who after 3 months' diet treatment had a mean of two fasting plasma glucose (FPG) concentrations of 6.1-15.0 mmol/L were randomly assigned intensive policy with a sulphonylurea (chlorpropamide, glibenclamide, or glipizide) or with insulin, or conventional policy with diet. The aim in the intensive group was FPG less than 6 mmol/L. In the conventional group, the aim was the best achievable FPG with diet alone; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment: any diabetes-related endpoint (sudden death, death from hyperglycaemia or hypoglycaemia, fatal or non-fatal myocardial infarction, angina, heart failure, stroke, renal failure, amputation [of at least one digit], vitreous haemorrhage, retinopathy requiring photocoagulation, blindness in one eye, or cataract extraction); diabetes-related death (death from myocardial infarction, stroke, peripheral vascular disease, renal disease, hyperglycaemia or hypoglycaemia, and sudden death); all-cause mortality. Single clinical endpoints and surrogate subclinical endpoints were also assessed. All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy.
FINDINGS: Over 10 years, haemoglobin A1c (HbA1c) was 7.0% (6.2-8.2) in the intensive group compared with 7.9% (6.9-8.8) in the conventional group--an 11% reduction. There was no difference in HbA1c among agents in the intensive group. Compared with the conventional group, the risk in the intensive group was 12% lower (95% CI 1-21, p=0.029) for any diabetes-related endpoint; 10% lower (-11 to 27, p=0.34) for any diabetes-related death; and 6% lower (-10 to 20, p=0.44) for all-cause mortality. Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25% risk reduction (7-40, p=0.0099) in microvascular endpoints, including the need for retinal photocoagulation. There was no difference for any of the three aggregate endpoints between the three intensive agents (chlorpropamide, glibenclamide, or insulin). Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis (both p<0.0001). The rates of major hypoglycaemic episodes per year were 0.7% with conventional treatment, 1.0% with chlorpropamide, 1.4% with glibenclamide, and 1.8% with insulin. Weight gain was significantly higher in the intensive group (mean 2.9 kg) than in the conventional group (p<0.001), and patients assigned insulin had a greater gain in weight (4.0 kg) than those assigned chlorpropamide (2.6 kg) or glibenclamide (1.7 kg).
INTERPRETATION: Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications, but not macrovascular disease, in patients with type 2 diabetes.(ABSTRACT TRUNCATED)

PMID 9742976
Abstract/Text Data from the Early Treatment Diabetic Retinopathy Study (ETDRS) show that focal photocoagulation of "clinically significant" diabetic macular edema substantially reduces the risk of visual loss. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. In this randomized clinical trial, which was supported by the National Eye Institute, 754 eyes that had macular edema and mild to moderate diabetic retinopathy were randomly assigned to focal argon laser photocoagulation, while 1,490 such eyes were randomly assigned to deferral of photocoagulation. The beneficial effects of treatment demonstrated in this trial suggest that all eyes with clinically significant diabetic macular edema should be considered for focal photocoagulation. Clinically significant macular edema is defined as retinal thickening that involves or threatens the center of the macula (even if visual acuity is not yet reduced) and is assessed by stereo contact lens biomicroscopy or stereo photography. Follow-up of all ETDRS patients continues without other modifications in the study protocol.

PMID 2866759
Abstract/Text The Branch Vein Occlusion Study is a multicenter, randomized, controlled clinical trial designed to answer several questions regarding the management of complications of branch vein occlusion. This report addresses the questions, "Can peripheral scatter argon laser photocoagulation prevent the development of neovascularization?" and "Can peripheral scatter argon laser photocoagulation prevent vitreous hemorrhage?" To answer the first question, 319 eyes were assigned randomly to either a treated or an untreated control group. Comparing treated patients with control patients (average follow-up time, 3.7 years), the development of neovascularization was significantly less in treated eyes (P = .009, log rank test). To answer the second question, 82 eyes were assigned randomly to either a treated or untreated control group. Comparing treated patients with control patients (average follow-up time, 2.8 years), the development of vitreous hemorrhage was significantly less in treated eyes (P = .005, log rank test). Although the Branch Vein Occlusion Study was not designed to determine whether peripheral scatter treatment should be applied before rather than after the development of neovascularization, data accumulated in this study suggest that peripheral scatter treatment should be applied after the development of neovascularization rather than before the development of neovascularization. Because the occurrence of vitreous hemorrhage was lessened by peripheral scatter argon laser photocoagulation, we recommend laser photocoagulation for patients with branch vein occlusion who have developed neovascularization and who meet the eligibility criteria of this study.

PMID 2417579
Abstract/Text The Branch Vein Occlusion Study is a multi-center, randomized, controlled clinical trial designed to answer several questions regarding the management of complications of branch vein occlusion. This report discusses the question, "Is argon laser photocoagulation useful in improving visual acuity in eyes with branch vein occlusion and macular edema reducing vision to 20/40 or worse?" One hundred thirty-nine eligible eyes were assigned randomly to either a treated or an untreated control group. Comparing treated patients to control patients (mean follow-up 3.1 years for all study eyes), the gain of at least two lines of visual acuity from baseline maintained for two consecutive visits was significantly greater in treated eyes (P = .00049, logrank test). Because of this improvement in visual acuity with argon laser photocoagulation of macular edema from branch vein occlusion, we recommend laser photocoagulation for patients with macular edema associated with branch vein occlusion who meet the eligibility criteria of this study.

PMID 6383055

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