视网膜裂孔伴玻璃体积血的临床分析

目的探讨急性玻璃体后脱离致视网膜裂孔伴玻璃体积血的治疗方式及疗效。方法回顾性分析31眼视网膜裂孔合并玻璃体积血，早期予双眼包扎、半卧位、止血，出血3d后予活血化瘀、促进玻璃体积血吸收治疗。根据病情变化采用激光封闭裂孔及行20G三通道闭合式玻璃体切除术治疗。所有病例至少随访12个月。结果23眼玻璃体积血在1周～3个月，平均（32．95±12．61）d吸收，采用视网膜激光治疗，裂孔完全封闭，视力无明显变化。4周内，3眼发生孔源性视网膜脱离，行玻璃体切除术治疗，术后1眼矫正视力提高，2眼矫正视力无明显提高。5眼玻璃体积血无明显吸收，2～4周内采用玻璃体切除术，术后视力明显提高，矫正视力0．3—0．6。结论急性玻璃体后脱离引起的视网膜裂孔伴玻璃体积血应引起高度重视。早期诊断并发现裂孔、及时光凝封闭裂孔是获得良好结果的关键。尽早手术是争取较好疗效的重要保障。

Clinical analysis of retinal tear associated with vitreous hemorrhage

Objective To discuss the treatment and efficacy of retinal tear associated with vitreous hemorrhage caused by acute posterior vitreous detachment. Methods 31 eyes with retinal tear with vitreous hemorrhage were included in the retrospective study. All cases were treated by binding up the eyes, semire- clining position, hemostasis and enhancing the blood clearance subsequently at the early state. Laser photo- coagulation or 20G pars plana vitrectomy were adopted depending on patients＇condition. All cases had a followed-up for at least 12 months. Results 23 eyes underwent laser photocoagulation making for blocking retinal tears with clearance of vitreous hemorrhage within 1 week to 3 month, mean time （32.95 ±12.61 ） days. Visual acuity of those cases were not influenced significantly. 3 eyes occurred rhegmatogenous retinal detachment within 4 weeks underwent vitrectomy. Postoperative corrected visual acuity of i in 3 eyes was improved and no change in 2 eyes. 5 eyes with no obvious vitreous hemorrhage absorption within 2 weeks to 4 weeks underwent vitrectomy. Postoperative visual acuity of 5 eyes were improved to be 0.3 - 0.6. Conclusion Retinal tear associated with vitreous hemorrhage caused by acute posterior vitreous detachment should be attended to. Early diagnosis with tears location and timely photocoagulation were the keys to win favorable result. Early vitrectomy also guaranted better visual acuity.