挫伤性脉络膜出血及脉络膜破裂（附135例报告）

眼球钝挫伤常引起脉络膜出血及脉络膜破裂，多发生于后极部，对视力危害较大，有的脉络膜出血及早期破裂不易诊断，常造成漏诊和误诊。本文对1985－1996年眼底荧光血管造影中135例挫伤性脉络膜出血及破裂进行了分析，并对其发生机制及新生血管膜的产生进行讨论。临床资料：（一）一般资料：135例中男性117例，女性18例，年龄7岁～53岁，平均24．5岁。右眼71眼，左眼64例。致伤原因以砖石泥团击伤最多占31％；其次为拳击占25％，其它有弹弓、球类、爆炸、射击等致伤。受伤距就诊时间最短1天，最常为15年，l月以内就诊71例占54．7％。视力＜0…     

荧光素眼底血管造影对脉络膜挫伤的诊断价值

目的 分析荧光素眼底血管造影(FFA)在脉络膜挫伤诊断中的价值.方法 对86例(86只眼)脉络膜挫伤常规进行散瞳后间接眼底镜及FFA检查.结果 86只眼中65只眼(75.83%)有脉络膜破裂,其中有50只眼破裂与出血并存.造影前检眼镜检查未发现脉络膜破裂者共6眼,占6.98%.结论 FFA能最大限度地发现脉络膜破裂,尤其是眼底镜下不能发现的微小、隐匿的破裂与出血,能准确地判断损伤部位、层次及损害程度.     

脉络膜挫伤荧光素眼底血管造影

目的分析荧光素眼底血管造影(FFA)在脉络膜挫伤诊断中的意义。方法81例(82眼)脉络膜挫伤进行FFA及常规眼科检查。结果82眼中63眼(76.83%)显示为脉络膜破裂。其中38眼破裂与出血并存。裂口<1DD者17眼,占26.98%。造影前眼底检查未发现裂口及出血者12眼,占14.63%。结论FFA能最大限度地发现脉络膜挫伤病灶,尤其是检眼镜下未能发现的微小、隐匿的破裂与出血;能客观地确定损伤部位、层次及程度范围。     

外伤性脉络膜破裂的眼底荧光血管造影检查

报告8例外伤性破裂患者的眼底荧光血管造影检查。本症多发于眼底后极，病灶多呈弧形，凹向视盘，作同心圆排例，病灶可多发，末端可分支。造影表现：脉络膜完全破裂者造影早期脉络膜毛细血管完全无灌注；晚期荧光素由周围组织向病灶扩散，使巩膜着色显高荧光；脉络膜板层破裂时，病灶区呈不规则脉络膜荧光灌注减弱；病灶愈合后，其边缘及内部可出现色素斑。 （中华眼底病杂志，1994，10：182-183）     

挫伤性脉络膜破裂出血

挫伤性脉络膜破裂出血新疆石河子医学院一附院眼科王开文，杨树楦，董永章自１９８８年以来，本室对眼挫伤病人连续进行眼底荧光血管造影观察。１１８例中发现脉络膜破裂出血者４６例（３９．０％），兹报告如下。一般临床资料４６例中男性４１例，女性５例。年龄最小８岁...     

眼挫伤116例眼底荧光血管造影分析

目的分析眼挫伤眼底改变及眼底荧光血管造影的表现。方法对116例(145眼)眼挫伤经直接检眼镜和三面镜检查及眼底荧光血管造影检查。结果眼挫伤视功能严重受损的主要原因是视网膜、视神经受损，常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血，视网膜脱离和视神经损伤。其中以视网膜震荡多见。结论对于眼挫伤的，只要屈光间质清晰，都应检查眼底，行眼底荧光血管造影检查，以判断眼底病损伤部位及损害程度。     

眼底荧光血管造影在眼挫伤中的临床应用及分析

目的:探讨眼挫伤的眼底改变及眼底荧光血管造影(fundusfluorescein angiography,FFA)的表现。方法:对272例325眼眼挫伤分别经直接检眼镜和三面镜检查及FFA检查并进行分析结果:眼挫伤可导致视功能严重受损,主要原因为视网膜、视神经的损伤,常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血,视网膜脱离和视神经损伤,其中以视网膜震荡多见。结论:对于眼挫伤都应常规检查眼底,条件允许的情况下都要行FFA检查,以判断眼底的损伤部位及程度。     

外伤性脉络膜破裂临床观察

目的探讨外伤性脉络膜破裂的临床特征、分型及眼底血管造影特点。方法回顾性分析17例（17只眼）外伤性脉络膜破裂患者临床资料。17例（17只眼）行荧光素眼底血管造影（FFA）检查，8只眼同时行脉络膜吲哚氰绿血管造影（ICGA）检查。结果FFA检查，17只眼中9只眼FFA早期病损部位呈条状或弯月形透见荧光或弱荧光，晚期呈现强、弱荧光或着染，或由于出血遮蔽难以显示破裂部位、大小及形态。ICGA检查，5只眼视网膜出血不多，早期表现为破裂灶周围脉络膜充盈缺损，破裂处可见脉络膜毛细血管断裂，大血管连续性良好，或者大血管亦断裂，晚期可清晰显示脉络膜破裂的部位、大小、形态及多少。3只眼合并浓厚的出血，造影早期亦看不到明显改变，晚期则可见破裂灶。结论外伤性脉络膜破裂如果合并眼底出血时，ICGA检查优于FFA，并可以根据ICGA检查将其分为脉络膜全层破裂和脉络膜毛细血管．玻璃膜一视网膜色素上皮复合体（CBRC）断裂。     

眼挫伤荧光素眼底血管造影临床分析

目的 分析眼挫伤眼底改变及荧光素眼底血管造影(FFA)的表现.方法 对268例(339只眼)眼挫伤经直接检眼镜和三面镜检查及FFA检查.结果 眼挫伤视功能严重受损的主要原因是视网膜、视神经受损,常见的有视网膜震荡、视网膜出血、黄斑裂孔、脉络膜破裂、出血,视网膜脱离和视神经损伤.其中以视网膜震荡多见.结论 对于眼挫伤患者,只要屈光间质清晰,都应检查眼底,行FFA检查,以判断眼底病损伤部位及损害程度.     

眼球挫伤眼底荧光血管造影(摘要)

严重的眼球挫伤导致严重的视功能障碍,通过眼底荧光血管造影(F、F、A)观察,有利于了解损伤程度及制订治疗方案和予设估计。我们自1987年至1989年共做FFA657例其中眼球挫伤6例(占0.9％),计视网膜震荡1例,脉络膜出血2例,视网膜脉络膜萎缩2例,脉络膜裂伤1例。由于黄斑裂孔一般毋需作FFA,故缺乏这方面的资料。严重的眼挫伤可见视网膜出血、水肿,脉络膜破裂、萎缩等表现。FFA可见相应变化。视网膜震荡伤导致水肿,这是眼球挫伤的基本病理改变,早期F、F、A大都无特殊变化,晚期色素上皮萎缩,透见荧光。视网膜脉络膜各层次的出血可见相应层次的荧光庶蔽,脉络膜出血呈相应的暗区,形如烧饼状。如出血在视盘旁则象猫耳朵状无荧光区。脉络膜破裂视不同深度,FFA表现有新差异。破裂在色素上皮层,早期可见脉络膜毛细血管背景荧光;破裂在玻璃膜及     

后部眼球壁灰褐色隆起物声像学诊断

目的：研究后部眼球壁灰褐色隆起物－脉络膜血肿及脉络膜黑色素瘤的声像学表现,以便对其进行声像学鉴别诊断。方法：对FFA确诊为脉络膜血肿和手术病理证实为脉络黑色素瘤的17例患者B超检查所见,进行声像学分析。结果：9例脉络膜血肿患者,B超检查表现为：6例后极部球壁局限性增厚,随增益降低出现层间透声裂隙,增益越低透声裂隙越明显,裂隙中散在弱回声光点;3例病变范围大、隆起高,与浅层视网膜脱离相似,但其光带较厚,缺乏后运动,且膜下见细小弱回声光点。8例脉络膜黑色素瘤中5例表现为球壁半球形实性隆起物,3例为蘑菇形。肿物在声像图上均表现为前缘光滑锐利,内回声前方多而强,向后渐少而弱,见脉络膜凹陷及后方声影,3例蘑菇形肿物均见头部周围及附近视网膜浅层脱离。结论：脉络膜血肿与脉络膜黑色素瘤的声像学表现有明显差异。     

视神经挫伤后的眼底血管造影

目的：用荧光素眼底血管造影（Fundus fluorescein angiography,FFA)和吲哚青绿血管造影（Indocyanine green angiography,IGGA)探讨视神经挫伤后，视神经及周围视网膜，脉络膜的循环改变。方法：对30例（30只眼）不同程度的眼球挫伤致视神经损伤的患者进行FFA与ICGA同步检查，并对它们的图像进行分析（本组除外脉络膜破裂）。结果：除1例视盘及周围视网膜，脉络膜荧光大致正常外，其余29例均出现了异常的荧光表现。FFA主要表现为：在造影早期视盘呈象限性或全视盘性的荧光充盈不良，后期荧光素渗漏或始终不能充盈，ICGA主要表现为：在FFA显示的视盘象限性弱荧光区的相邻区域脉络膜充盈时间明显延迟；FFA显示的全视盘性的弱荧光，盘周的脉络膜充盈时间明显延长，在局限性脉络膜灌注不良的对应区均出现了视网膜色素上皮（Retinal pigment epithelium,RPE)的损害，而盘周脉络膜灌注不良的区域，有9例相应区视网膜并未出现RPE的损害；有2例合并视网膜分支动脉阻塞；有19例视盘缺血的部分正是“分水区”的位置，占63.3%，本组病例中有80%视力在0.1以下。结论：眼球挫伤不仅可使视神经损伤，其周围的视网膜，脉络膜均可受到损害，应尽早施行FFA与ICGA检查，它可以详细观察，正确判断视神经挫伤后的视盘缺血情况及周围视网膜，脉络膜损害的范围和程度，及时正确地指导治疗。     

Posterior segment injury developed after injection of anesthetics on eyelids with needleless jet injection device

Background Though a needleless jet injection device (NJI device) has advantages over a conventional needle attached syringe for injecting anesthetics, safety of using it for lid surgery is not proved. We report a case of posterior segment injury suspected caused by a NJI device.Methods A 47-year-old woman presented with decreased visual acuity after regional anesthesia at the lower eyelids with a NJI device.Results Vitreous and subretinal hemorrhage was found associated with retinal edema adjacent to the optic disc of the right eye and around the inferior temporal arcade of the left eye. Fluorescein angiography revealed choroidal rupture in the both eyes. By 2 months, although the hemorrhage resolved, subretinal fibrosis and chorioretinal atrophy developed. Her vision decreased to 20/60 in the right eye and 20/40 in the left eye.Conclusion The energy generated by the NJI device seemed to have reached the eyeballs to cause the blunt-typed posterior segment injuries. As choroidal rupture may result in a permanent visual loss, the risks associated the off-labeled use of the device for lid surgeries should be awakened.The authors have full control of all primary data and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data.     

Rupture of the choroid after eyeball contusion--an analysis based on the Erlangen Ocular Contusion Registry (EOCR)

BACKGROUND: Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by acute subretinal haemorrhage. We analysed possible predictive factors and functional results of eyeballs with rupture of the choroid after ocular contusion. PATIENTS AND METHODS: We performed a retrospective study of 376 consecutive inpatients (Erlangen Ocular Contusion Registry - EOCR, over a 10-year period), who were treated because of a blunt eye injury at our eye hospital (86 % males). Detailed notes regarding the anterior and posterior segments were extracted from the standardised charts. Mean age was 28.8 +/- 16.1 years (4 to 84 years). Eyes with previous trauma or globe ruptures were excluded. RESULTS: Twenty-six of 376 patients developed choroidal rupture due to ocular contusion (6.9 %). A choroidal rupture was more frequent in females (9.4 %) than in males (6.5 %). Patients with choroidal rupture were treated as inpatients 5 days longer than patients without (10.7 vs. 5.5 days; p < 0.001). Twenty-two percent of the injuries occurred during work time. Main causes of choroidal ruptures were water jet (19 %), fireworks (12 %), elastic cords (12 %), metal pieces (12 %), gotcha (8 %) and champagne corks (8 %). The risk for developing a choroidal rupture due to water jet or fireworks injuries was increased 9 or 4 times. Ninety-two percent of choroidal ruptures were located at the posterior pole and concentric, 40 % were submacular, 12 % outside the large temporal vessels (4 % were located both centrally and peripherally). Initial visual acuity (VA) and VA at discharge were decreased significantly in eyes with rupture of the choroid (20/200 and 20/60) in contrast to eyes without (20/40 and 20/25; p < 0.001). Choroidal ruptures were often associated with iridodialysis, lens dislocation and contusion cataract (3 x ), vitreous haemorrhage (4 x ), complete retinal defects (6 x ), ciliary body clefts (7 x ) or hyphema rebleeding (4 x ). No association between the height of hyphema and choroidal ruptures was found. The predictive level of choroidal ruptures was 40 % in eyes with a combination of lens dislocation, traumatic cataract and vitreous bleeding. The final VA was 20/200 or less in 11 eyes associated with a prevalence of 55 % of ruptures submacularly. In contrast to this, eyes with VA > 20/200 developed 26 % submacular choroidal ruptures. CONCLUSIONS: Additional severe traumatic changes of the anterior and posterior segment were found 2 - 7 times more frequently in eyes with choroidal ruptures compared to eyes without those ruptures. The visual improvement was limited due to submacular ruptures. Frequent ophthalmological controls are recommended to minimise the risk of choroidal neovascularisation in a submacular location.     

Blunt ocular trauma. Part II. Blunt posterior segment trauma

This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin's edema (35%) and retinal detachment (5-7%) are frequent after ocular contusion. In cases of central Berlin's edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14-20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27 x) (in females 5 x).     

Stumpfes Augentrauma

This review presents typical patterns of posterior segment injuries as well as diagnostic and therapeutic considerations after ocular contusion or rupture of the globe. Vitreal prolapse is associated with retinal detachment (20%), iridodialysis or ciliary body cleft (43%), and contusion cataract (41%). Berlin’s edema (35%) and retinal detachment (5–7%) are frequent after ocular contusion. In cases of central Berlin’s edema, choroidal infarction (Hutchinson-Siegrist-Neubauer syndrome) or choroidal rupture, macular hole or choroidal neovascularization should be ruled out. A central choroidal rupture is often associated with choroidal neovascularization (14–20%). Globe ruptures (5% of blunt injuries) are associated with hyphema grades III and IV (58 vs 5% in ocular contusions). The prognosis of globe ruptures to develop a visual function <20/200 is 51 times more frequent than in eyes with contusion. The risk of trauma-induced globe ruptures is higher in eyes after cataract surgery (27×) (in females 5×).     

Intravitreal bevacizumab injection in patients with choroidal neovascularization due to choroid rupture after blunt-head trauma

Purpose To describe and report the effect of intravitreal bevacizumab (Avastin) as primary treatment for secondary choroidal neovascularization (CNV) after choroidal rupture due to blunt-head trauma. Design Interventional case report. Methods The study was of the left eye of a patient who presented with choroidal neovascularization secondary to choroidal rupture due to blunt-head trauma. The patient received single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab as treatment for CNV after informed consent was signed. The patient underwent fundus fluorescein angiography (FA) and optic coherence tomography (OCT) before the bevacizumab injection and then again three months after. Visual acuity was also measured before and after treatment. The patient was re-examined on the first day, and monthly thereafter. After intravitreal injection of bevacizumab the visual and anatomic responses were observed. Results The patient showed regression of the neovascularization three months after injection of bevacizumab. There was no loss of vision in the immediate postoperative period and at the 3rd month vision improved from 20/60 to 20/20. Central retinal thickness decreased. No cataract progression, endophthalmitis, or injection-related complications were observed. Conclusions Our study shows that intravitreal 1.25 mg bevacizumab can be an effective alternative treatment for choroidal neovascularization (CNV) due to choroidal rupture. The authors have no proprietary interest in the material used in this study.     

Alteration in choroidal blood flow produced by local pressure

Background To investigate how transient pressure applied to the retinal pigment epithelium (RPE) layer and choroid affects choroidal blood flow in rabbits.Methods Twelve rabbits underwent vitrectomy and local retinectomy. In nine of the rabbits a glass rod was used to exert brief pressure on the RPE layer and choroid. Three of the rabbits had no pressure indentation and were considered to be controls. The choroidal circulation was studied by indocyanine green (ICG) angiography. The retina and choroid were studied by postmortem histology.Results Pressure on the RPE layer and choroid caused nonfluorescence in segments of retinal arteries and veins and reduced fluorescence in adjacent choroidal capillaries, producing a black region at the pressure site in the angiograms. The size of this region decreased during the angiogram, often accompanied by the appearance of fine channels considered to be flow through the partially blocked vessels; the obstructed ends of the vessels became increasingly hyperfluorescent. These changes lasted for about 24 h before the choroidal circulation recovered. Histology showed evidence of thrombotic-like material in choroidal arteries and veins at the areas of absent perfusion. After local retinectomies, there was no evidence of thrombosis in control eyes where no pressure had been applied.Conclusion Brief pressure on the RPE and choroid causes immediate reduction in flow through choroidal vessels, which appears to be due to local thrombosis in small segments of these vessels that resolves slowly. This may reflect a tendency for thrombi to form rapidly in choroidal vessels; it may also depend on neural reflexes causing vasoconstriction. The long time course of recovery could result in retinal ischemia and may underlie the pathophysiology of other pressure insults to the choroid.     

Indocyanine green angiographic features of choroidal rupture and choroidal vascular injury after contusion ocular injury

PURPOSE: To report features of choroidal rupture and choroidal vascular injury after contusion ocular injury on indocyanine green angiography. METHODS: In a prospective study, nine patients (nine eyes) with choroidal rupture after ocular contusion underwent initial fluorescein angiography and indocyanine green angiography within 19 days after trauma. Eyes that had a distinct abnormality of the retinal pigment epithelium were excluded from this study. Subtraction indocyanine green angiography was also performed. Follow-up fluorescein angiographic and indocyanine green angiographic findings were also studied. RESULTS: Initial ophthalmoscopic examination revealed subretinal hemorrhage in all nine eyes. In five of the nine eyes, choroidal rupture was not seen on initial ophthalmoscopic or fluorescein angiographic examination because it was hidden beneath the subretinal hemorrhage, but it was detected on subsequent examinations. In the remaining four eyes, choroidal rupture was observed by ophthalmoscopy at the time of initial examination, and these eyes exhibited hyperfluorescent streaks on fluorescein angiography in the region of the subretinal hemorrhage. On initial indocyanine green angiography of all nine eyes, observed hypofluorescent streaks became more obvious with time. For each eye, there were more hypofluorescent streaks on indocyanine green angiography than hyperfluorescent streaks on fluorescein angiography. In one eye, the location of indocyanine green leakage nearly coincided with the location of a hyperfluorescent streak on fluorescein angiography. In this case, crescentic streaks of hypofluorescence were seen on the temporal side of the subretinal hemorrhage on indocyanine green angiography, although choroidal rupture was not observed in that region by ophthalmoscopy or fluorescein angiography. In two of the nine eyes, indocyanine green angiography and the subtraction technique demonstrated disturbance of flow into choroidal vessels, especially at the choroidal rupture site. CONCLUSION: After ocular contusion injury, various features of choroidal rupture and choroidal vascular injury were observed on indocyanine green angiography. This technique may contribute to the diagnosis of choroidal rupture and to the understanding of the clinical course after injury.