玻璃体切除术治疗息肉状脉络膜血管病变并发玻璃体积血的疗效

  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。

Effectiveness of Vitrectomy for Polypoidal Choroidal Vasculopathy Associated with Vitreous Hemorrhage

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 I〉 0. 3 in 4 eyes, I〉 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.