玻璃体切割手术治疗息肉状脉络膜血管病变引起的玻璃体积血的疗效观察

Efficacy of vitrectomy for vitreous hemorrhage in patients with polypoidal choroidal vasculopathy

目的观察玻璃体切割手术治疗息肉状脉络膜血管病变（PCV）引起的玻璃体积血的疗效。方法伴玻璃体积血的PCV患者14例14只眼纳入研究。男性8例8只眼，女性6例6只眼。平均年龄（58．7±6．0）岁。均行常规眼科检查，以及A／B型超声、荧光素眼底血管造影、吲哚青绿血管造影等检查确诊。行常规玻璃体切割手术，手术中切除玻璃体积血，手术结束时行硅油或C3F8气体填充。手术后行光动力疗法（PDT）治疗8只眼。观察患眼视网膜复位情况、视力改善状况、病变稳定程度以及手术后并发症发生情况。结果14只眼中，治愈6只眼，占42．9％；好转7只眼，占50．0％；无效或加重1只眼，占7．1％。1次手术后视网膜复位良好10只眼。视网膜复位不良4只眼。其中，再次注人硅油后视网膜复位1只眼；再次C3F8填充后视网膜复位1只眼；下方裂孔1只眼行巩膜外垫压手术后视网膜复位；未行特殊处理1只眼，硅油维持。最终视网膜复位13只眼，占92．9％，手术后1～7d出现前房积血5只眼，经前房冲洗或药物治疗积血吸收，眼压稳定。视力提高2行以上者1只眼，1～2行者1只眼，不变10只眼，下降2只眼。行PDT治疗的8只眼中，异常血管消退5只眼，未消退3只眼。结论对于伴玻璃体积血的PCV行玻璃体切割手术清除玻璃体积血，恢复屈光间质透明性，手术后联合PDT治疗，对稳定或提高视功能有一定的疗效。

Objective To observe the efficacy of vitrectomy for vitreous hemorrhage in patients with polypoidal ehoroidal vasculopathy （PCV）. Methods Fourteen patients （14 eyes） of PCV with vitreous hemorrhage diagnosed by routine ophthalmologic examination, A and/or B mode ultrasound, fundus fluorescein angiography （FFA） and indocyanine green angiography （ICGA） were enrolled in this study. The patients included eight males （eight eyes） and six females （six eyes）, with the mean age of （58. 7＋6.0） years. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were eight eyes received photodynamic therapy （PDT） after surgery. The retinal reattachment, visual acuity, pathological lesion degree and complications were comparatively analyzed. Results Among 14 eyes, six eyes （42.9%） recovered, seven eyes （50.0%） improved, and one eye （7.1%） aggravated. Ten eyes achieved retinal reattachment after surgery, while four eyes developed retinal detachment after the first surgery. The retina remained attached in these three eyes after silicon oil tamponade, C3F8 gas tamponade and scleral buckling, respectively; but one eye maintained silicon oil without special treatment. Thirteen eyes （92.9 %） achieved retinal reattachment finally. Five eyes of them occurred hyphema one to seven days after surgery, but hyphema was absorbed and intraocular pressure was stable after douche of anterior chamber and pharmacotherapy. The vision improved with more than two lines in one eyes, improved with one to two lines in one eye, unchanged in 10 eyes, and decreased in two eyes. Of eight eyes who underwent PDT, abnormal vessels regressed in five eyes, abnormal vessels remained in three eyes. Conclusions Vitrectomy can remove cloudy refracting media for PCV with vitreous hemorrhage. The combined treatment of vitrectomy and PDT can improve or stabilize visual function,is an effective therapy for the PCV with vitreous hemorrhage.