玻璃体切割治疗玻璃体积血的临床疗效观察

Effects of vitrectomy for vitreous hemorrhage

目的:探讨玻璃体切割治疗玻璃体积血的临床疗效。方法:对72例75眼玻璃体积血患者采用玻璃体切割手术治疗,术中根据具体病情联合单纯白内障摘除或白内障摘除联合人工晶状体植入术、眼内异物取出、膜剥离、水下透热、眼内光凝或/和巩膜外冷凝及眼内注气或硅油充填。结果:选取75眼中外伤性玻璃体积血(穿孔性眼外伤19眼,眼球钝挫伤8眼)27眼,视网膜静脉阻塞15眼,增殖期糖尿病视网膜病变12眼,Eales病9眼,视网膜裂孔合并玻璃体积血9眼,年龄相关性黄斑病变3眼。术后随访6～48(平均18±5.6)mo,75眼中72眼视力有不同程度的提高,>0.05者65眼(87%),>0.2者54眼(72%),>0.5者23眼(31%),术后视力没有提高3眼(4%),术后视力与术前相比差异具有统计学意义(P<0.05)。结论:严重的眼外伤合并玻璃体积血、大量玻璃体积血药物治疗不吸收,反复发生的玻璃体积血和B超检查发现视网膜脱离者应及时行玻璃体切割术以改善和保护视功能。

AIM：To evaluate the therapeutic effects of vitrectomy for vitreous hemorrhage.METHODS：Seventy-five eyes of seventy-two patients with vitreous hemorrhage due to varied etiology underwent pars plana vitrectomy combined with cataract removal and/or IOL implantation,extraction of intraocular foreign bodies,membrane peeling,endodiathermy,endophotocoagulation,transscleral cryotherapy and long-acting tamponades according to particular situation respectively.RESULTS：Diagnosis included：traumatic vitreous hemorrhage（27 eyes）,retinal branch/central vein obstruction（15 eyes）,proliferative diabetic retinopathy（12 eyes）,Eales＇ disease（9 eyes）,rhegmatogenous vitreous hemorrhage（9 eyes）,age-related macular degeneration（3 eyes）.Postoperative follow-up ranged from 6 to 48 months（mean,18.6 months）.The final visual acuity improved in 72 eyes（96%）.Of the 75 eyes,65 eyes（87%） had a best postoperative visual acuity of 0.05 or better,54 eyes（72%） had visual acuity of 0.2 or better,23 eyes（30.66%） had visual acuity of 0.5 or better,only 3 eyes visual acuity didn＇t improved（4%）.There was significant difference between preoperative and postoperative vision（P0.05）.CONCLUSION：Vitreous hemorrhage with serious ocular trauma,massive and unresolved vitreous hemorrhage,repeat vitreous hemorrhage or retinal detachment found with B-ultrasonic examination should timely undergo vitrectomy to improve and protect their visual acuity.