微创玻璃体视网膜手术治疗视网膜大动脉瘤性玻璃体积血

Micro-invasive vitrectomy for vitreous hemorrhage secondary to retinal arterial macroaneurysm

目的 观察微创玻璃体视网膜手术联合眼内激光光凝治疗视网膜大动脉瘤致玻璃体积血的临床疗效及安全性.方法 回顾性分析2008年3月至2010年8月因不明原因大量玻璃体积血病人,经术中眼底检查及术后荧光素眼底血管造影（fundus fluorescein angiography,FFA）明确诊断为视网膜大动脉瘤患者10例（10只眼）.所有患眼均行23G （Guage）联合25G经结膜无缝合玻璃体切割术,术中联合眼内激光光凝治疗,其中2例患者玻璃体腔内注入全氟乙烷（C2F6）气体.术后随访（18.6±10.03）月（3～32个月）.观察最佳矫正视力、眼压及术中术后并发症等.结果 术前最佳矫正视力平均为0.03±0.02（手动/20 cm ～ 0.06）；所有患者术后l周及末次随访最佳矫正视力均提高,分别为0.24±0.14 （0.05～0.4）、0.36±0.21 （0.1～0.6）,与术前比较,差异均具有统计学意义（分别为t =-4.72,P＜0.01; t=-4.94,P＜0.0l）.末次随访最佳矫正视力恢复至0.3及以上者7只眼（70％）.术前1天、术后1d、3d、术后末次随访眼压分别为（9.87±3.23）、（11.91±4.66）、（10.47±2.83）、（11.94±2.89） mmHg,四者比较差异无统计学意义（F =0.895,P＞0.05）.所有病例在术中及术后无严重并发症发生,且随访期内未见动脉瘤体再次破裂出血等复发情况.结论 微创玻璃体视网膜手术联合眼内激光光凝是治疗视网膜大动脉瘤致玻璃体积血的有效方法.

Objective To evaluate the safety and efficacy of micro-invasive vitrectomy combined with endophotocoagulation in cases with dense vitreous hemorrhage secondary to retinal arterial macroaneurysm. Methods Retrospective,consecutive,interventional cases series of 10 eyes of 10 patients with retinal arterial macroaneurysm who underwent 3-port pars plana vitrectomy and endophotocoagulation using 23-guage instrumentation combined with 25-gauge infusion.Follow-up ranged from 3 to 32 months （mean,18.6±10.03 months）.Main outcome measures included pre and post operation best-corrected visual acuity （BCVA）,intraocular pressure,and complications. Results The postoperative visual acuities improved in all eyes.The mean BCVA improved from 0.03±0.02 （ranged from hand motions to 0.06） preoperatively to 0.24±0.14 （ranged from 0.05 to 0.4） at the one week after surgery and there was a significant statistical difference between them （t =-4.72,P 〈0.01）.At the final follow-up,the BCVA was 0.36±0.21 （ranged from 0.1 to 0.6）,and vision was better than 0.3 in seven eyes.There was a significant statistical difference between pre-operation and the final follow-up （t =-4.94,P 〈0.01）.The intraocular pressure of one day before operation,one day after operation,three day after operation and the final follow-up were （9.87±3.23）,（11.91±4.66）,（10.47±2.83）,（ll.94±2.89）mmHg respectively,no statistically significant difference was found among them （F=0.895,P〉0.05）.No serious complications and recurrenee occurred. Conclusions Micro-invasive vitrectomy combined with endophotocoagulation is a feasible treatment for cases with dense vitreous hemorrhage secondary to retinal arterial macroaneurysm.