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Œdèmes maculaires pp 107–130Cite as

Occlusions veineuses rétiniennes

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Résumé

Les occlusions veineuses rétiniennes (OVR) ont été définies comme des désordres vasculaires rétiniens caractérisés par la dilatation des veines rétiniennes associées à des hémorragies rétiniennes et sous-rétiniennes, à un œdème maculaire et/ou à une ischémie rétinienne.

L’angiographie à la fluorescéine (AF) reste essentielle pour le diagnostic et le pronostic des OVR, permettant le diagnostic de diverses formes d’OVR, telles que des formes « perfusées ou non perfusées » aussi bien que la détection des diverses modalités au cours de l’évolution spontanée. L’AF est la méthode la plus efficace pour déterminer la présence (ou l’absence) de l’œdème maculaire cystoïde, son extension, sa persistance, sa régression, ou le degré d’ischémie. L’OCT en Spectral Domain (SD-OCT) permet de quantifier les modifications d’épaisseur rétinienne, l’accumulation d’œdème maculaire cystoïde et fournit des informations supplémentaires. Le SD-OCT met en évidence la présence et l’intégrité de la membrane limitante externe ainsi que des segments internes et externes des photorécepteurs, information particulièrement utile pour le pronostic et le traitement.

La photocoagulation au laser, selon une forme en « grid » sur l’ensemble de la région mise en évidence par la diffusion de la fluorescéine, était encore le traitement de référence pour l’œdème maculaire lié aux occlusions de branches veineuses rétiniennes, selon les résultats de l’étude dite SCORE.

Des études récentes de séries cliniques et des études cliniques, randomisées et prospectives, suggèrent fortement un effet anti-œdémateux des stéroïdes intravitréens, entraînant une amélioration de l’acuité visuelle. Ces études ont montré que les stéroïdes intravitréens (triamcinolone, fluocinolone, et mieux encore dexaméthasone avec libération prolongée) et les injections d’anti-VEGF par voie intravitréenne (bevacizumab, ranibizumab, pégaptanib) peuvent, au moins temporairement, diminuer l’œdème fovéal et de ce fait améliorer l’acuité visuelle.

Des modalités chirurgicales de traitement ont aussi été proposées pour les OVR. L’action positive de la vitrectomie semble durable ; la combinaison de la chirurgie et des injections intravitréennes des stéroïdes et/ou des injections d’activateur du plasminogène pourraient permettre une action plus rapide et plus durable. Des données plus précises provenant d’études contrôlées sont en attente.

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Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany

    Jost Jonas

  2. Hôpital des Quinze-Vingts et Institut de la vision, Paris

    Michel Paques

  3. Service d’ophtalmologie, Hôital intercommunal de Créteil, université Paris XII, Créteil, Paris, France

    Agnès Glacet-Bernard

  4. Institut de la Màcula i de la Retina, Barcelona, Spain

    Jordi Mones

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  4. Agnès Glacet-Bernard
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Jonas, J., Paques, M., Mones, J., Glacet-Bernard, A. (2011). Occlusions veineuses rétiniennes. In: Œdèmes maculaires. Springer, Paris. https://doi.org/10.1007/978-2-8178-0118-6_7

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