玻璃体切割手术治疗不同类型玻璃体积血的临床研究

Clinical research of different types of vitreous hemorrhage with vitrectomy

目的:观察不同原因导致玻璃体积血玻璃体切割的疗效及年龄等相关因素对玻璃体切割手术疗效影响。方法:回顾性分析76例通过玻璃体切割手术治疗的玻璃体积血患者76眼的资料,按玻璃体积血原因、发病年龄和玻璃体积血时间分组,并进行统计学分析。结果:在导致玻璃体积血原因中,糖尿病性视网膜病变(增生性)患者31例(41%),孔源性视网膜脱离24例(32%),视网膜分支静脉阻塞10例(13%),视网膜中央静脉阻塞3例(4%)。视网膜血管炎2例(3%),眼球钝挫伤2例(3%),单纯玻璃体积血2例(3%),增生性玻璃体视网膜病变1例(1%),息肉样脉络膜血管病变1例(1%)。各年龄组病因构成存在统计学差异(χ2=21.89,P<0.01)。年龄<45岁的青年组中,有26例,孔源性视网膜脱离导致玻璃体积血患者最多,共11例,占42%。年龄在45～59的中年组中,有19例,孔源性视网膜脱离导致玻璃体积血患者最多,共9例,占47%。年龄>60的老年组中,有31例,糖尿病性视网膜病变(增生性)导致玻璃体积血患者最多,共24例,占77%。在玻璃体积血时间分组中,各时间组术后视力存在统计学差异(χ2=20.37,P<0.01)。1mo组共26例,术后视力主要为>0.3,共13例,占50%。2mo组共24例,术后视力主要为0.1～0.3,共10例,占42%。3mo组共11例,术后视力主要为0.01～0.09,共5例,占45%。>3mo组共15例,术后视力0.01～0.09和0.1～0.3,各6例,分别占40%。结论:糖尿病性视网膜病变(增生性)、孔源性视网膜脱离和视网膜分支静脉阻塞是导致玻璃体积血的主要原因。玻璃体切割手术治疗玻璃体积血安全有效,可以在一定程度上提高患者视力。玻璃体积血患者在1～2mo内手术,疗效较好。

AIM： To observe the clinical efficacy ofvitrectomy on different causes of vitreous hemorrhage, and the effect of correlative factor on vitrectomy. METHODS： Clinical data of different types offundus disease in 76 cases 76 eyes with vitrectomy were analyzed retrospectively. The multiple factors related with clinical efficacy of vitrectomy including the causes, age and the time were analyzed. RESULTS： In cause groups, diabetic retinopathy（proliferative） was in 31 cases （41%）, rhegmatogenous retinal detachment 24 cases （32%）, branch retinal vein occlusion 10 cases （13%）, central retinal vein occlusion 3 cases （4%）, retinal vasculitis 2 cases （3%）, blunt trauma 2 cases （3%）, simple vitreous hemorrhage 2 cases （3%）, proliferative vitreoretinopathy 1 case （1%）, polypoidal choroidal vasculopathy 1 case （1%）. In age groups, there was statistical difference between each group（χ2=21.89, P〈0.01）; in youth group（〈45）, there were 26 cases, rhegmatogenous retinal detachment was in 11 cases （42%）; in middle-aged group （45-59）, there were 19 cases, rhegmatogenous retinal detachment was in 9 cases （47%）; in old group（〉60）, there were 31 cases, diabetic retinopathy was in 24 cases（77%）. In time groups, there was statistical difference between each group（χ2=20.37, P〈0.01）; in one month group, there were 26 cases, the postoperative vision of 13 cases （50%） increased over 03; in two month group, there were 24 cases, the postoperative vision of 10 cases （42%） increased over 0.1 but below 0.3, in three month group, there were 11 cases, the postoperative vision of 5 cases （45%） increased over 0.01 but below 0.09; in over three month group, there were 15 cases, the postoperative vision of 6 cases（40%） increased over 0.01 but below 0.09 and 6 cases （40%） increased over 0.1 but below 0.3. CONCLUSION： The diabetic retinopathy（ptoliferative）, rhegmatogenous retinal detachment and branch retinal vein occlusion are the main causes of the vitreous hemorrhage. Vitrectomy used to treat different causes of vitreous hemorrhage is obviously effective （especially caused by rhegmatogenous retinal detachment）, which can improve visual function. The vitrectomy has better clinical efficacy on vitreous hemorrhage in one to two months.