老年性黄斑变性所致大量视网膜下及玻璃体积血的手术治疗

Surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age-related macular degeneration

目的 探讨老年性黄斑变性 (age- related macular degeneration,AMD)所致大量视网膜下及玻璃体积血的手术治疗的方法及疗效。 方法 回顾分析 14例手术前后经荧光素眼底血管造影 (fundus fluo-rescein angiography ,FFA)确诊为 AMD所致的大量视网膜下及玻璃体积血患者的 14只患眼 ,行经睫状体平坦部玻璃体切割、单个小切口的视网膜切开、用平衡盐液进行视网膜下冲洗、气液交换、视网膜切口的眼内激光光凝、气体或硅油填充等手术治疗后 ,随访 3～ 7个月的临床资料。 结果 14只患眼中 2只患眼术后眼球萎缩 ,占 14.3% ;12只患眼视力均获得不同程度的提高 ,占 85 .7% ;最好的矫正视力为 0 .2 ;12只患眼术后随访时间内视网膜保持平复 ,占 85 .7% ;4只患眼术后 7d内出现前房泥沙样积血 ,占 2 8.6 % ,行 1～3次前房冲洗术。 结论 玻璃体视网膜手术能有效清除 AMD所致的视网膜下及玻璃体积血 ,对预防和治疗视网膜下及玻璃体积血所致的前房泥沙样积血、血影细胞性青光眼及视网膜脱离等有积极意义。

Objective To investigate the method and the effects of the surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age related macular degeneration. Methods A retrospective study of 14 consecutive patients underwent a complete pars plana vitrectomy. Retinotomy was carried out for removing subretinal hemorrhage by using balanced salt solution. Complete air fluid exchange and gas or silicone oil tamponade were performed in all patients. The follow up period was within 3～7 months. Results Atrophy of eyeball in 2 eyes (14.3%) postoperatively. Improvement of corrected final visual acuity and anatomical retinal reattachment were achieved in 12 (85.7%) of the 14 eyes postoperatively. Seven days after operation, muddy sand hemorrhage in anterior chamber occurred in 4 (28.6%) of the eyes and paracenteses of anterior chamber were performed for these eyes. Conclusion Surgical intervention should be applied in the eyes with the massive subretinal hemorrhage associated with age related macular degeneration in order to avoid the affected eyes becoming atrophic due to the subsequent complication of vitreous hemorrhage, anterior chamber muddy sand hemorrhage,ghost cell glaucoma or retinal detachment.