Effectiveness of Vitrectomy for Polypoidal Choroidal Vasculopathy Associated with Vitreous Hemorrhage
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摘要:
目的 探讨玻璃体切除术治疗息肉状脉络膜血管病变(polypoidal choroidal vasculopathy, PCV)并发玻璃体积血的临床疗效。 方法 回顾性分析2007年7月至2012年8月北京协和医院收治的29例(29只眼)首诊为玻璃体积血, 玻璃体切除术后确诊为PCV患者的临床资料, 其中男性18例, 女性11例; 年龄40~84岁, 平均(61.5±11.5)岁。术前视力:光感者5只眼, 手动者17只眼, 眼前数指者3只眼, < 0.1者3只眼, ≥ 0.1者1只眼。29只眼均给予玻璃体切除术, 其中13只眼给予C3F8填充, 14只眼给予硅油填充。14只眼合并白内障行摘除术。术后随访1~84周, 平均33周。 结果 术后23只眼视力提高, 占79.3%;6只眼视力不变, 占20.7%。末次随诊, 视力≥ 0.3者4只眼, ≥ 0.1者6只眼, ≥ 0.01者9只眼, 眼前手动与眼前数指者各5只眼。术前与术后视力比较, 差异具有统计学意义(t=6.032, P < 0.05)。术后视网膜在位28只眼, 其中8只眼为硅油填充下视网膜在位; 视网膜脱离1只眼。29只眼手术中均见视网膜下大量出血。术后视网膜下出血均有不同程度吸收, 其中7只眼积血完全吸收, 仅见色素紊乱及机化膜。 结论 玻璃体切除术可以有效治疗继发于PCV的玻璃体积血, 提高患者视力; 合并视网膜脱离时联合硅油或惰性气体填充可使大部分患者获得视网膜解剖复位及视力改善。 -
关键词:
- 玻璃体积血 /
- 息肉状脉络膜血管病变 /
- 玻璃体切除术
Abstract:Objective To evaluate the effectiveness of vitrectomy in treating polypoidal choroidal vasculopathy (PCV) associated with vitreous hemorrhage. Methods We retrospectively analyzed the clinical data of 29 patients (18 males and 11 females, 29 eyes) who were first diagnosised as vitreous hemorrhage and ultimately confirmed to be with PCV after the standard pars plana vitrectomy (PPV) between July 2007 and August 2012 in our hospital. These patients aged 40 to 84 years (mean:61.5±11.5 years). The best corrected visual acuity (BCVA) was light perception in 5 eyes, hand moving in 17 eyes, counting finger in 3 eyes, < 0.1 in 3 eyes, and ≥ 0.1 in 1 eye. PPV were performed in all 29 eyes, among which 13 were given gas tamponade and 14 were given oil tamponade. Cataract extraction was performed for 14 eyes. The follow-up lasted 1 to 84 weeks (mean:33 weeks). Results The BCVA was improved in 23 eyes (79.3%), and remained stable in 6 eyes (20.7%). At the end of the follow-up, the BCVA was ≥ 0.3 in 4 eyes, ≥ 0.1 in 6 eyes, ≥ 0.01 in 9 eyes, counting finger in 5 eyes, and hand moving in 5 eyes. The BCVA showed significant difference before and after the operation(t=6.032, P < 0.05). Retina remained attached in 28 eyes, including 8 eyes with silicone oil tamponade. Nevertheless, retina detachment was observed in one patient. All these 29 eyes had massive subretinal hemorrhage during the surgery, which was somehow absorbed after the surgery. In 7 patients, the blood was completely absorbed, leaving exudative membrane or pigment disorder. Conclusions PPV is effective for the treatment of vitreous hemorrhage in PCV patient. When in combination with silicone oil or gas resules, it can achieve retinal reattachment and improve the vision in most patients. -
表 1 玻璃体切除术前后患者视力变化
表 2 玻璃体切除术前后患者最佳矫正视力及视力评分
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[1] Yannuzzi LA, Sorenson J, Spaide RF, et al. Idiopathic polypoidal choroidal vasculopathy[J]. Retina, 1990, 10:1-8. http://europepmc.org/abstract/med/22451948 [2] Uyama M, Wada M, Nagai Y, et al. Polypoidal choroidal vasculopathy:natural history[J]. Am J Ophthalmol, 2002, 133:639-648. doi: 10.1016/S0002-9394(02)01404-6 [3] 于文贞, 陈欢, 赵敏, 等.非外伤非糖尿病视网膜病变性玻璃体积血病因分析及手术疗效[J].中华实用眼科杂志, 2011, 29:262-266. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyykzz201103019 [4] Shukla D, Kanungo S, Prasad NM, et al. Surgical outcomes for vitrectomy in Eales' disease[J]. Eye (Lond), 2008, 22:900-904. doi: 10.1038/sj.eye.6702763 [5] Liu Y, Wen F, Huang S, et al. Subtype lesions of neovascular age-related macular degeneration in Chinese patient[J]. Graefes Arch Clin Exp Ophthalmol, 2007, 245:1441-1445. doi: 10.1007/s00417-007-0575-8 [6] Glatt H, Machemer R. Experimental subretinal hemorrhage in rabbits[J]. Am J Ophthalmol, 1982, 94:762-773. doi: 10.1016/0002-9394(82)90301-4 [7] Toth CA, LMorse LS, Hjelmeland LM, et al. Fibrin directs early retinal damage after experimental subretinal hemorrhage[J]. Arch Ophthalmol, 1991, 109:723-729. doi: 10.1001/archopht.1991.01080050139046 [8] Lincoff H, Madjarov B, Lincoff N, et al. Pathogenesis of thevitreous cloud emanating from subretinal hemorrhage[J]. Arch Ophthalmol, 2003, 121:91-96. doi: 10.1001/archopht.121.1.91 [9] Sakamoto T, Sheu SJ, Arimura N, et al. Vitrectomy for exudative age-related macular degeneration with vitreous hemorrhage[J]. Retina, 2010, 30:856-864. doi: 10.1097/IAE.0b013e3181c969cb [10] Sandhu SS, Manvikar S, Steel DH. Displacement of submacular hemorrhage associated with age-related macular degeneration using vitrectomy and submacular tPA injection followed by intravitreal ranibizumab[J]. Clin Ophthalmol, 2010, 21:637-642. http://europepmc.org/articles/PMC2909894/ [11] Hillenkamp J, Surguch V, Framme C, et al. Management of submacular hemorrhage with intravitreal versus subretinal injection of recombinant tissue plasminogen activator[J]. Graefes Arch Clin Exp Ophthalmol, 2010, 248:5-11. doi: 10.1007/s00417-009-1158-7 [12] Fine HF, Iranmanesh R, Del Priore LV, et al. Surgical outcomes after massive subretinal hemorrhage secondary to agerelated macular degeneration[J]. Retina, 2010, 30:1588-1594. doi: 10.1097/IAE.0b013e3181e2263c [13] Shiraga F, Matsuo T, Yokoe S, et al. Surgical treatment of submacular hemorrhage associated with idiopathic polypoidal choroidal vasculopathy[J]. Am J Ophthalmol, 1999, 128:147-154. doi: 10.1016/S0002-9394(99)00078-1 [14] Jung JH, Lee JK, Lee JE, et al. Results of vitrectomy for breakthrough vitreous hemorrhage associated with age-related macular degeneration and polypoidal choroidal vasculopathy[J]. Retina, 2010, 30:865-873. doi: 10.1097/IAE.0b013e3181c969e9