Progress in the retinal vascular obstruction associated with anti-phospholipid antibodies

doi:10.3877/cma.j.issn.2095-2007.2022.06.009

Abstract

Abstract:

In recent years, anti-phospholipid antibody-related retinal vascular obstruction (RVO) has been gradually concerned, especially in the onset of young and small groups with no high-risk factors such as hypertension and diabetes, etc. RVO associated with anti-phospholipid antibody should be excluded once they were diagnosed as RVO. The pathogenesis of anti-phospholipid antibody-associated RVO is mainly associated with thrombosis caused by anti-phospholipid antibodies, which including reducing prostacyclin synthesis, platelet aggregation, the inhibition of protein C activation, reducing fibrinolysis, and promoting neutrophil activation, etc. The RVO associated with anti-phospholipid antibodies has many clinical characteristics, such as no specific age of onset, no uniqueness of symptoms and signs, and a diversity of laboratory findings. The current treatment mainly focuses on antithrombosis and treatment and prevention of ocular neovascular complications. The former includes antiplatelet drugs, anticoagulant drugs, human intravenous immunoglobulin, plasma exchange, thrombolytic therapy, and application of recombinant tissue plasminogen activator; and the latter includes retinal laser coagulation, intravitreal injection of anti-vascular endothelial growth factor or dexamethasone implant for injection. However, the treatment plan of the original disease is divided on the control effect of the local eye condition, and more evidence-based basis is needed to further standardize the treatment plan of the disease.

Key words: Anti-phospholipid antibodies, Retinal vascular occlusion, Clots, Coagulation

Ziyang Chen, Like Xie, Xiaofeng Hao, Xiaoyan Zhang. Progress in the retinal vascular obstruction associated with anti-phospholipid antibodies[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(06): 367-371.

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References 49

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第一作者	年份(年)	病例简述	特点
Lu等^[47]	2022	患者女性，12岁。CRVO，实验室检查仅见anti－β2GPⅠ为31.46 RU/mL稍高。予阿司匹林肠溶片口服，150 mg/d，玻璃体内注射地塞米松玻璃体内植入剂，术后恢复正常，随访1年未复发。	玻璃体内注射地塞米松玻璃体内植入剂疗效佳。
Joäo等^[49]	2022	患者男性，11岁。CRVO伴ME，实验室检查aCL、anti－β2GPⅠ及LA IgG均升高。给予低分子肝素和全身类固醇激素，3 d后病情加重，视力下降为光感，予华法林维持治疗12个月，BCVA恢复至数指，视网膜内层和视神经萎缩。	给予抗凝剂和激素后病情仍可能继续加重，改用华法林治疗。
Moreno－Páramo等^[32]	2019	患者男性，14岁。CRVO和CRAO，实验室检查aCL、anti－β2GPⅠ及LA均为阳性。给予激素和口服抗凝药7 d后，由于凝血时间延长，出现玻璃体积血，给予玻璃体切割术联合视网膜激光凝固术联合玻璃体腔注射雷珠单抗注射液，随访1年未见新生血管以及血栓再发生。	抗凝药使用应注意检测凝血时间，由于凝血时间延长导致的玻璃体出血有继发新生血管性青光眼的风险。
Korematsu等^[16]	2014	患者女性，15岁。CRVO，实验室检查aCL、anti－β2GPⅠ及LA IgG均为阴性，而抗磷脂酰胆碱、抗磷脂酰乙醇胺、抗磷脂酰肌醇IgG抗体及磷脂酰丝氨酸IgG抗体水平升高。给予低分子肝素、类固醇激素、华法林、阿司匹林、泼尼松龙及他克莫司等治疗，病情好转。	APS实验室诊断标志物可能为非标准标志物异常，如抗磷脂酸、磷脂酰乙醇胺、磷脂酰肌醇、磷脂酰胆碱及磷脂酰甘油等。
Modrzejewska等^[9]	2013	患者女性，1个月。CRVO，实验室检查aCL IgG升高，aCL IgM和aβ2GPⅠ正常。其母亲确诊为APS，给予局部滴眼液治疗，视力提高。	发病年龄最小，具有家族史。

第一作者	年份(年)	病例简述	特点
Lu等^[47]	2022	患者女性，12岁。CRVO，实验室检查仅见anti－β2GPⅠ为31.46 RU/mL稍高。予阿司匹林肠溶片口服，150 mg/d，玻璃体内注射地塞米松玻璃体内植入剂，术后恢复正常，随访1年未复发。	玻璃体内注射地塞米松玻璃体内植入剂疗效佳。
Joäo等^[49]	2022	患者男性，11岁。CRVO伴ME，实验室检查aCL、anti－β2GPⅠ及LA IgG均升高。给予低分子肝素和全身类固醇激素，3 d后病情加重，视力下降为光感，予华法林维持治疗12个月，BCVA恢复至数指，视网膜内层和视神经萎缩。	给予抗凝剂和激素后病情仍可能继续加重，改用华法林治疗。
Moreno－Páramo等^[32]	2019	患者男性，14岁。CRVO和CRAO，实验室检查aCL、anti－β2GPⅠ及LA均为阳性。给予激素和口服抗凝药7 d后，由于凝血时间延长，出现玻璃体积血，给予玻璃体切割术联合视网膜激光凝固术联合玻璃体腔注射雷珠单抗注射液，随访1年未见新生血管以及血栓再发生。	抗凝药使用应注意检测凝血时间，由于凝血时间延长导致的玻璃体出血有继发新生血管性青光眼的风险。
Korematsu等^[16]	2014	患者女性，15岁。CRVO，实验室检查aCL、anti－β2GPⅠ及LA IgG均为阴性，而抗磷脂酰胆碱、抗磷脂酰乙醇胺、抗磷脂酰肌醇IgG抗体及磷脂酰丝氨酸IgG抗体水平升高。给予低分子肝素、类固醇激素、华法林、阿司匹林、泼尼松龙及他克莫司等治疗，病情好转。	APS实验室诊断标志物可能为非标准标志物异常，如抗磷脂酸、磷脂酰乙醇胺、磷脂酰肌醇、磷脂酰胆碱及磷脂酰甘油等。
Modrzejewska等^[9]	2013	患者女性，1个月。CRVO，实验室检查aCL IgG升高，aCL IgM和aβ2GPⅠ正常。其母亲确诊为APS，给予局部滴眼液治疗，视力提高。	发病年龄最小，具有家族史。

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