自发性黄斑区出血性视网膜脱离的临床特征

目的 分析自发性黄斑区出血性视网膜脱离的临床特征，提高对本病的诊治水平。 方法 对1998年9月至2003年3月我院眼底病科临床确诊的黄斑区视网膜下出血，范围大于4 DD×5 DD的患者，共23例（23只眼）的连续临床资料进行回顾性分析。经荧光素眼底血管造影 （FFA）、吲哚青绿血管造影（ICGA）及B型超声波检查，进行病因分析，随诊观察视力及眼底变化。 结果 23例患者均表现为视力突然减退至0.2以下或光感。23只眼中7只眼确诊为老年性黄斑变性的脉络膜新生血管（CNV）；5只眼为息肉状脉络膜血管病变（PCV）；2只眼为视网膜大动脉瘤；9只眼病因不明。23只眼中3只眼积血吸收，黄斑中心凹无瘢痕形成，视力恢复0.4～0.8；12只眼黄斑出血区形成机化瘢和色素增生，视力数指/眼前～0.2；另外8只眼并发玻璃体积血，其中3只眼行玻璃体切割术，黄斑区大片机化及瘢痕，视力数指/66 cm～0.2；5例视力丧失。 结论 自发性出血性视网膜脱离多发生于老年人，视力突然下降或丧失。出血形态表现为局灶性或弥漫性，因黄斑区组织严重损害，大部分病例预后差。 (中华眼底病杂志, 2006, 22: 228-231)

Clinical features of retinal detachment in macular spontaneous hemorrhage

Objective To analyze the clinical features of retinal detachment in macular spontaneous hemorrhage to improve the level of diagnosis and treatment of this disease. Methods The serial clinical data of 23 patients (23 eyes) with subretinal hemorrhage in macular region with the area over 4DD×5DD who were diagnosed in our hospital from Sep, 1998 to Mar, 2003 were analyzed retrospectively. The patients included 12 males (12 eyes) and 11 females (11 eyes) with the average age of 64.1 (47-75). Fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and B-scan examination were performed on the patients to analyze the pathogenic factors, and the visual acuity and manifestation of ocular fundus were observed during the 8-24 months followed-up period. Results The visual acuity decreased to less than 0.2 or light perception suddenly in all affected eyes. In 23 eyes, choroidal neovascularization (CNV) of age-related macular degeneration (AMD) was found in 7, polypoidal choroidal vasculopathy (PCV) was in 5, retinal macroaneurysm was in 2, and unknow pathogenic factor in 9. Among the 23 eyes, hemorrhage was absorbed and no cicatritial formation at the fovea in 3 eyes with the visual acuity of 0.4-0.8; scar and pigment proliferation in the hemorrhage area were seen in 12 eyes with the visual acuity of finger counting (FC) to 0.2; combined vitreous hemorrhage was found in 8 eyes, including massive scar in the macular area in 3 who had undergone vitrectomy with the visual acuity of FC/66cm to 0.2 and blindness in the other 5 eyes. Conclusion Spontaneous hemorrhagic retinal detachment always arises in old people whose symptoms were sudden decrease or loss of the visual acuity. The configuration of the hemorrhage is local and diffuse. The prognosis of the visual acuity of most of the patients is poor due to the serious tissue injury in macula area. (Chin J Ocul Fundus Dis, 2006, 22: 228-231)