{"id":3053,"date":"2013-11-07T15:37:27","date_gmt":"2013-11-07T15:37:27","guid":{"rendered":"https:\/\/www.materdomini.it\/malattie\/occlusione-venosa-retinica\/"},"modified":"2018-03-06T11:31:14","modified_gmt":"2018-03-06T11:31:14","slug":"occlusione-venosa-retinica","status":"publish","type":"disease","link":"https:\/\/www.materdomini.it\/malattie\/occlusione-venosa-retinica\/","title":{"rendered":"Occlusione venosa retinica"},"content":{"rendered":"<p style=\"text-align: justify;\">L\u2019<strong>occlusione venosa retinica<\/strong>\u00a0si riscontra pi\u00f9 frequentemente in pazienti con et\u00e0 superiore ai 60 anni, che presentano fattori predisponenti quali: ipertensione arteriosa, diabete mellito, disturbi cardiocircolatori, fumo, anomalie della coagulazione, bronco pneumopatie ostruttive e, a livello oculare: glaucoma, ipermetropia, alcune vasculiti retiniche e rare anomalie congenite della vena centrale della retina.<\/p>\n<p style=\"text-align: justify;\">L\u2019ostruzione del flusso ematico venoso, provocata dalla coagulazione intravascolare, comporta una serie di conseguenze a carico dei tessuti retinici interessati che soffrono l\u2019ostacolo all\u2019afflusso di sangue arterioso e di conseguenza il deficit di ossigeno, e l\u2019accumulo dei prodotti di scarto del metabolismo.<\/p>\n<p style=\"text-align: justify;\">L&#8217;<strong>occlusione venosa retinica<\/strong> pu\u00f2 colpire la vena centrale della retina globalmente (occlusione della vena centrale della retina) o solo un suo ramo (occlusione di branca della vena centrale della retina).<\/p>\n<h2 style=\"text-align: justify;\">Occlusione Della Vena Centrale (Ovcr)<\/h2>\n<p style=\"text-align: justify;\">\u00c8\u00a0l&#8217;occlusione della vena retinica nella sua porzione terminale, a livello del nervo ottico.<\/p>\n<p style=\"text-align: justify;\">Si distinguono due forme:<\/p>\n<ul>\n<li style=\"text-align: justify;\"><strong>non ischemica<\/strong> (75% dei casi): caratterizzata da emorragie diffuse nel tessuto retinico spesso accompagnate da edema maculare, responsabili di calo visivo da moderato a marcato. Il calo visivo \u00e8 percepito dal paziente per il suo esordio improvviso o comunque rapido, in poche ore\/giorni;<\/li>\n<li style=\"text-align: justify;\"><strong>ischemica<\/strong> (pi\u00f9 rara): con emorragie diffuse e specificamente localizzate a livello maculare ed estese aree di ischemia da non perfusione capillare. La perdita della vista \u00e8 spesso molto grave e, se non trattata, il 50% dei pazienti potr\u00e0 sviluppare entro qualche mese un glaucoma neovascolare, caratterizzato da un marcato aumento della pressione intraoculare difficilmente controllabile con farmaci, con conseguente dolore oculare e rischio di perdita del bulbo oculare.<\/li>\n<\/ul>\n<h2 style=\"text-align: justify;\">Occlusione Venosa Di Branca (Ovbr)<\/h2>\n<p style=\"text-align: justify;\"><span style=\"text-align: justify;\">\u00c8<\/span>\u00a0l\u2019occlusione di un ramo della vena centrale della retina.<\/p>\n<p style=\"text-align: justify;\">L&#8217;occlusione venosa si presenta improvvisamente, o comunque rapidamente (in poche ore\/giorni), con pi\u00f9 o meno marcato annebbiamento della vista e talvolta perdita di parte del campo visivo.<\/p>\n<p style=\"text-align: justify;\">La retina presenta emorragie ed edema nel territorio irrorato dal vaso interessato.<\/p>\n<p>Tra le complicanze capaci di determinare deficit visivo:<\/p>\n<ul>\n<li>Edema della parte retinica centrale (edema maculare)<\/li>\n<li>Assenza di irrorazione della parte centrale della retina (ischemia maculare)<\/li>\n<li style=\"margin-bottom: 0.0001pt; line-height: normal;\">Emorragie intraoculari da proliferazione di vasi sanguigni anomali formatisi come esito di mancata irrorazione del distretto retinico coinvolto.<\/li>\n<\/ul>\n<h2>La Diagnosi<\/h2>\n<p style=\"text-align: justify;\">La diagnosi dell&#8217;<strong>occlusione venosa retinica<\/strong> avviene durante una <strong>visita oculistica completa<\/strong>, che comprenda l&#8217;esame dell&#8217;acuit\u00e0 visiva (vista), l&#8217;esame del fondo oculare (esame fondamentale), la misurazione del tono oculare e l\u2019attenta valutazione dell\u2019iride e dell\u2019angolo irido-corneale mediante gonioscopia, alla ricerca di una eventuale proliferazione neovascolare.<\/p>\n<p style=\"margin-bottom: 0.0001pt; line-height: 150%; text-align: justify;\">Gli esami strumentali che confermano la diagnosi, indirizzano al trattamento pi\u00f9 adeguato e permettono di studiare l&#8217;evoluzione della malattia sono: la <a href=\"http:\/\/www.materdomini.it\/pazienti\/diagnosi\/diagnostica-oftalmologica\/4272-angiografia-retinica-a-fluorescenza-fluorangiografia\"><strong>fluorangiografia retinica <\/strong><\/a>(per valutare la presenza di ischemia retinica) e l&#8217;<a href=\"http:\/\/www.materdomini.it\/pazienti\/diagnosi\/diagnostica-oftalmologica\/4271-oct-tomografia-ottica-a-radiazione-coerente\"><strong>OCT<\/strong><\/a> (permette di individuare la presenza di edema maculare).<\/p>\n<h2>I Trattamenti<\/h2>\n<h3 style=\"text-align: justify;\">Trattamento Argon Laser per occlusione vascolare retinica<\/h3>\n<p style=\"text-align: justify;\">Il laser \u00e9 un dispositivo capace di emettere un sottile raggio di luce che coagula il tessuto retinico interessato mediante effetto termico.<\/p>\n<p style=\"text-align: justify;\">Nell&#8217;occlusione venosa retinica il trattamento laser \u00e9 finalizzato a:<\/p>\n<ul>\n<li style=\"text-align: justify;\">ridurre l\u2019edema maculare (griglia maculare)<\/li>\n<li style=\"text-align: justify;\">prevenire la formazione di neovasi secondari all\u2019ischemia retinica (fotocoagulazione pan-retinica)<\/li>\n<\/ul>\n<h3 style=\"text-align: justify;\">Griglia maculare<\/h3>\n<p style=\"text-align: justify;\">L&#8217;applicazione di spot laser a bassa energia al centro della retina stimola il riassorbimento dell\u2019edema maculare. Questo trattamento consente miglioramenti visivi lievi o minimi e solo in occhi con capacit\u00e0 visiva non seriamente compromessa. Si uutilizza in particolare nelle forme di occlusione venosa centrale. Sono pertanto oggi disponibili trattamenti innovativi, basati sull\u2019iniezione intravitreale di sostanze anti-VEGF o di desametazone, da effettuarsi in alternativa o in combinazione alla griglia maculare laser.<\/p>\n<h3 style=\"text-align: justify;\">Fotocoagulazione pan-retinica<\/h3>\n<p style=\"text-align: justify;\">Consente la distruzione mediante cicatrizzazione delle aree ischemiche periferiche da cui si formano neovasi anomali e, quindi, previene gravi complicanze quali sanguinamento intraoculare e glaucoma neovascolare.<\/p>\n<p style=\"margin-bottom: 0.0001pt; line-height: normal; text-align: justify;\">Nessun trattamento laser \u00e9 invece indicato nelle forme di ischemia maculare.<\/p>\n<h2>La Prevenzione<\/h2>\n<p style=\"text-align: justify;\">I fattori di rischio che predispongono all\u2019<strong>occlusione vascolare retinica<\/strong> sono molteplici e, in genere, sono gli stessi che si riscontrano in alterazioni vascolari che coinvolgono altri distretti corporei come nel caso di ictus o coronaropatie.<\/p>\n<p style=\"text-align: justify;\">La <strong>prevenzione primaria<\/strong> si avvale della identificazione e opportuno trattamento dei fattori di rischio vascolare, pi\u00f9 spesso di origine sistemica.<\/p>\n<p style=\"text-align: justify;\">La <strong>prevenzione secondaria<\/strong> si basa sulla precoce identificazione e classificazione del disturbo vascolare oculare, allo scopo di limitare, con l\u2019opportuno trattamento locale e sistemico, la progressione dello stesso verso forme pi\u00f9 avanzate.<\/p>\n<p style=\"margin-bottom: 0.0001pt; line-height: normal; text-align: justify;\">\u00c8\u00a0fondamentale che l\u2019approccio preventivo e il percorso clinico terapeutico sia di tipo multidisciplinare, coinvolgendo, accanto all\u2019oculista, gli specialisti pi\u00f9 indicati per il caso specifico (cardiologo, internista, ematologo, reumatologo<span style=\"font-size: 10pt; font-family: 'Arial','sans-serif';\">).<\/span><\/p>\n<p 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