影响出血型息肉状脉络膜血管病变治疗预后的出血特征

目的：探讨影响出血型息肉状脉络膜血管病变（PCV）疗效的出血特征。方法：前瞻性研究。收集 2015年1月到2017年12月在温州医科大学附属眼视光医院眼底内科就诊的新发PCV经治疗且随访 至少3个月的患者。根据基线视网膜下出血面积是否>4视盘面积（DA），出血是否累及黄斑中心凹， 出血中心位于早期糖尿病视网膜病变治疗研究（ETDRS）环位置等进行分组，观察各组治疗前后 LogMAR视力变化，分析影响出血型PCV治疗后视力的出血特征。采用混合线性模型进行统计分析。 结果：共收集患者122例（124眼），其中男84例，女38例，年龄（64.9±9.8）岁。基线有视网膜下出血 69眼（55.6%）。其中，出血>4 DA的34眼（49.3%）治疗后视力较基线改善程度不如≤4 DA者明显，但 差异无统计学意义。基线出血累及中心凹59眼（85.5%）治疗后视力较基线改善程度不如未累及者明 显（F=3.92，P=0.01）。出血累及中心凹的59眼中，出血中心位于ETDRS 1环的25眼（42.4%）治疗后 视力较基线改善程度不如2、3环明显（F=2.23，P=0.05）。结论：视网膜下出血面积大，出血累及中心凹， 出血中心距黄斑中心凹近，是伴有视网膜下出血PCV患者视力预后差的特征因素。

Hemorrhagic Characteristics Associated with the Prognosis of Polypoidal Choroidal Vasculopathy with Subretinal Hemorrhage

Objective: To investigate the hemorrhagic characteristics associated with the treatment prognosis of polypoidal choroidal vasculopathy (PCV) with subretinal hemorrhage. Methods: This was a prospective study. Patients who were included had been diagnosed with naïve PCV from January 2015 to December 2017 in the Eye Hospital, Wenzhou Medical University, and were followed up for at least 3 months after the treatment. The logarithm of the minimum angle of resolution (logMAR) visual acuity during the follow-up after treatment were compared with baseline in different groups: A hemorrhage area of >4 disc area (DA) or less, whether or not there was foveal involvement, and the location of the center of the subretinal hemorrhage based on the Early Treatment Diabetic Retinopathy Study (ETDRS) ring. Data were recorded and analyzed by mixed linear models. Results: One hundred twenty-two patients (124 eyes) were enrolled, including 84 males and 38 females. The mean age was 64.9±9.8 years. Subretinal hemorrhage was presentin 69 eyes (55.6%) at baseline. Among them, a larger hemorrhage area (>4 DA) in 34 eyes (49.3%) showed poorer visual improvement during the follow-up period than a smaller hemorrhage area (≤4 DA) in 35 eyes (50.7%). The fovea was involved in 59 eyes (85.5%) and showed poorer visual improvement during the follow-up than 10 eyes without foveal involvement (F=3.92, P=0.01). Among the 59 eyes with foveal involvement, 25 eyes (42.4%) with the center of the hemorrhage located within ETDRS ring 1 showed poorer visual improvement than eyes with the central hemorrhage ring at 2 or beyond (F=2.23, P=0.05). Conclusion: Large area, foveal involvement, and proximity to the fovea are risk factors for the poor prognosis of PCV with subretinal hemorrhage.