脉络膜新生血管伴自发性脉络膜上腔出血的临床分析

Clinical analysis of choroidal neovascularization with spontaneous suprachoroidal hemorrhage

目的：描述脉络膜新生血管（choroidal neovascularization，CNV）伴自发性脉络膜上腔出血患者的临床特征，探讨其发生的高危因素以及玻璃体视网膜手术的疗效。方法：CNV伴自发性脉络膜上腔出血3例3眼，男性，年龄58～75（平均62岁）。玻璃体脉络膜积血病程6～12d（平均8±4．3d）。术前视力2眼手动，1眼无光感。眼压16～28mmHg（平均19±4．8mmHg）。2眼伴前房红褐色积血，3眼伴重度玻璃体混浊。FFA显示既往均有黄斑区CNV，其中1例健眼有玻璃膜疣。屈光力正常。眼轴22～24mm，双眼无显著性差异（P〉0．05）。B超均显示玻璃体积血、出血性视网膜脱离并脉络膜脱离。所有患者均接受常规脉络膜上腔放血、巩膜外环扎、玻璃体切割、视网膜切开、血管膜和积血块清除、视网膜复位及眼内硅油充填术。追踪观察6～34mo。结果：所有患者均为一次手术即成功引流脉络膜上腔积血，术中发现脉络膜下液为黑红色血性积液，玻璃体积血呈灰黑色，术毕脉络膜和视网膜平复。术后2眼发生前部增殖性玻璃体视网膜病变（anterior proliferative vitreoretinopathy, aPVR），1眼再次手术。最终在取出硅油后，2眼（67％）视网膜获得解剖复位，术后视力0．05～0．1，1眼无光感。结论：CNV所致的自发性脉络膜上腔出血伴出血性视网膜脱离非常少见，这类患者眼部病变发展迅速，脉络膜上腔积血可渗透到前房，眼压正常或偏高。玻璃体视网膜手术可取得较好的效果。

AIM： To describe the clinical characteristics of patients with choroidal neovascularization （CNV） and spontaneous suprachoroidal hemorrhage, and to investigate the high-risk factors and therapeutic effects of vitreoretinal surgery.METHODS： Three male patients （3 eyes）, aged 58 to 75 years old （mean, 62 years old）, who had choroidal neovascularization with spontaneous suprachoroidal hemorrhage were studied. Vitreous and choroidal hemorrhage lasted for 6 to 12 days （mean, 8±4.3 days）. Preoperative visual acuity was as follows： 2 eyes were hand movement; 1 eye had no light perception. Intraocular pressure （lOP） ranged from 16mmHg to 28mmHg （mean, 19 ± 4. 8mmHg）. 2 eyes were accompanied by hyphema with fuscous-rufous color. 3 eyes had severe vitreous opacity. Fundus fluorescein angiography （FFA） showed CNV was in the macular area previously in all cases and drusen of Bruch＇s membrane was in the fellow eye in one case. Refractive power was normal. Ocular axis ranged from 22mm to 24mm, and there was no significant difference compared with the fellow eye （ P 〉 0. 05）. Type B ultrasonography showed vitreous hemorrhage, hemorrhagic retinal detachment and choroidal detachment. All cases underwent drainage of suprachoroidal blood, episcleral cerclage, vitrectomy, retinotomy, removal of vascular membrane and blood clots, reattachment of retina and silicone oil tamponade. Patients were followed up for 6 to 34 months. RESULTS： Drainage of suprachoroidal hemorrhage succeeded in all cases by one operation, It was found in the operation that subchoroidal fluid was dark red liquefied blood, and the vitreous hemorrhage appeared grey black. The choroid and retina were flat at the end of operation. After the operation, 2 eyes developed anterior proliferative vitreoretinopathy （aPVR）, of which 1 eye underwent the second surgery. Finally 2 eyes （67%） obtained anatomic retinal reattachment. Postoperative visual acuity was 0.05-0.1 after the removal of silicone oil. 1 eye which was not operated again had no light perception. CONCLUSION. The spontaneous suprachoroidal hemorrhage caused by CNV combined with hemorrhagic retinal detachment is very rare. The ocular pathological process developed rapidly, and the hemorrhage in the epichoroidal space can penetrate into the anterior chamber, leading to normal or high lOP. The vitreoretinal surgery can improve the prognosis.