玻璃体积血合并内界膜下出血的手术治疗

目的 探讨眼纯挫伤和颅脑外伤合并内界膜下出血的玻璃体积血的临床特点及处理方法.方法 我们收治的合并内界膜下出血的玻璃体积血患者9例14眼,其中眼部纯挫伤3例3眼,Terson综合征5例11眼.手术采用轴性玻璃体切割联合内界膜剥离或切除清除内界膜下积血.结果 术前视力均为手动～数指/眼前,术后视力0.5～1.0.手术对于出血病程较短患者的视力提高效果较好,最佳视力为1.0;而病程较长者的最佳视力0.6.对于内界膜术中剥离时,根据病程的长短,采取剥离和切除的方法;对于陈旧性出血,术中不能完全清除,术后5～10 d内自行吸收.随访6个月～3 a.均保持较为稳定的视力.结论 2种情况均可以造成内界膜下出血及玻璃体积血,手术量可以根据玻璃体积血的形态做轴性玻璃体切割,内界膜切除不是目的,关键在于吸除其下的积血.

Surgery of vitreous hemorrhage combined with sub-inner limiting membrane hemorrhage

Objective To explore clinical characteristics and treatment of vitreous hemorrhage combined with sub-inner limiting membrane (sub-ILM) hemorrhage in the cases of ocular blunt trauma and craniocerebral injury. Methods Nine cases (14 eyes) with vitreous hemorrhage combined with sub-ILM hemorrhage underwent axial vitrectomy and ILM peeling or cutting to clear off sub-ILM hemorrhage,including 3 eyes of 3 cases with ocular blunt trauma and 11 eyes of 6 cases with Terson syndrome. Results The preoperative visual acuity was to count fingers with hand movement in front of eyes, and postoperative visual acuity ranged from 0.5 to 1.0. Patients with a short course of bleeding got better vision than those with a long course, and the best visual acuity was 0.6. According to the duration of case history, the ILM in the hemorrhagic areas were cut or peeled off. The remote hemorrhage, which could not be completely removed by surgery, was absorbed during postoperative 5 to 10 days. Relatively stable vision remained during followed-up for 6 months to 3 years. Conclusions Both two situations can cause vitreous hemorrhage and sub-ILM hemorrhage. According to the form of vitreous hemorrhage,axial vitrectomy can be a choice. Cutting ILM is not the purpose,but the key point is to draw off sub-ILM hemorrhage.