微创玻璃体手术治疗息肉样脉络膜血管病变合并玻璃体出血
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Observation of polypoidal choroidal vasculopathy with vitreous hemorrhage treated by microincision 25G pars plana vitrectomy
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    摘要:

    目的:评估息肉样脉络膜血管病变(PCV)患者合并玻璃体出血(VH)行玻璃体手术的疗效,总结病例的临床特点。

    方法:回顾研究2014-01/2017-12在我院就诊经25G微创玻璃体手术治疗的14例15眼PCV合并VH且随访超过6mo以上的患者的临床资料。收集病史信息及随访观察资料。观察指标包括:视力、眼压、眼部超声检查、彩色眼底像、眼底血管造影检查、光学相干断层扫描、手术并发症。分析患者的术前、术后最佳矫正视力(BCVA,LogMAR)的差异,并总结病例的临床特点及治疗效果。

    结果:PCV合并VH患者中11例合并高血压病史。9眼在术前已诊断PCV。随访时间为6~36mo。15眼均采用微创玻璃体手术治疗,术中3眼硅油填充,2眼气体填充,余眼内灌注液填充。术后并发症包括:白内障核性混浊加重2眼、复发VH 1眼、高眼压1眼、视网膜脱离0眼。术前BCVA为2.78±0.46,末次随访BCVA为1.15±0.50,术后较术前提高(t=11.14,P<0.01)。

    结论:微创玻璃体手术是治疗PCV合并VH的安全有效方式,可改善视力。高血压病史可能是PCV合并VH的危险因素。

    Abstract:

    AIM: To evaluate the efficacy of vitreous hemorrhage(VH)in patients with polypoidal choroidal vasculopathy(PCV), and to summarize the clinical characteristics of the cases.

    METHODS: Retrospective case series. From Jan. 2014 to Dec. 2017, 14 patients(15 eyes)with PCV combined with VH were treated by microincision 25G vitrectomy in our hospital and were followed up for at least 6mo. Data of medical history and follow up observation were collected. The main outcome measures included visual acuity, intraocular pressure, ultrasonography, color fundus photography, fundus angiography, optical coherence tomography, and surgical complications. To analyze the difference of the best corrected visual acuity(BCVA, LogMAR)between pre-operation and postoperation, and to summarize the clinical characteristics and therapeutic effect of the cases.

    RESULTS: Totally 11 cases had history of hypertension. 9 eyes were diagnosed with PCV before vitrectomy. The follow-up period was from 6-36mo. All 15 eyes were treated with microincision 25G vitrectomy. During the operation, 3 eyes were silicone oil tamponade in the vitreous cavity, 2 eyes were gas tamponade, and the remaining eyes were balanced saline solution tamponade. Postoperative complications included progressed cataract in 2 eyes, recurrent VH in 1 eye, high intraocular pressure in 1 eye, and recurrent retinal detachment in 0 eye. The BCVA before surgery was 2.78±0.46, and the last follow up BCVA after surgery was 1.15±0.50. Postoperative BCVA was significantly improved compared with the preoperation(t=11.14, P<0.01).

    CONCLUSION: Microincision vitrectomy is a safe and effective way to treat PCV with VH, which can improve the visual acuity of patients with PCV companied with VH. The history of hypertension may be a risk factor for PCV with VH.

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杨艳,李静,梁军,等.微创玻璃体手术治疗息肉样脉络膜血管病变合并玻璃体出血.国际眼科杂志, 2020,20(3):571-575.

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  • 收稿日期:2019-09-10
  • 最后修改日期:2020-02-17
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  • 在线发布日期: 2020-03-13
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