532nm激光治疗首发症状为玻璃体积血的视网膜裂孔

Treatment of Retinal Tear Starting from Vitreous Hemorrhage in Retina with 532 nm Laser

目的评估532nm激光治疗首发症状为玻璃体积血的视网膜裂孔的治疗效果。方法回顾性分析玻璃体积血的视网膜裂孔65例65只眼，采用532nm激光光凝视网膜裂孔周围3～4排，裂孔缘翘起或裂孔周围浅脱离者扩大光凝范围。发现跨越裂孔或裂孔边缘小血管，针对小血管光凝。激光治疗后定期复诊。结果激光治疗后玻璃体积血吸收，视网膜裂孔周围光凝斑色素均匀，裂孔消失。术后2个月内再次发生玻璃体积血4只眼（占6．15％）。结论对于首发症状为玻璃体积血的视网膜裂孔，尽早发现裂孔，在积血尚未弥散前，采用532nm激光光凝视网膜裂孔及跨越裂孔或裂孔边缘小血管，能够有效防止视网膜脱离及玻璃体积血反复发生，减少或避免了玻璃体手术。

Objective To evaluate the therapeutic effect of 532 nm laser on retinal tear starting from vitreous hemorrhage in retina. Methods Altogether 65 cases and 65 eyes diagnosed of vitreous hemorrhage because of retinal tear were retrospectively analyzed. Photocoagulation with 532 nm laser was used in 3-4 rows around the retina, and the photocoagulation scope was expanded for retinal tear with cocked edge or lightly-detached surrounding. Small blood vessels across the stage or in the edge were photocoagulated. Regular follow-up visits were given after the laser treatment. Results Among the 65 patients, 65 eyes of vitreous hemorrhage, 29 eyes were at Grade Ⅰ, accounting for 44. 6%, and 36 eyes Grade Ⅱ or Ⅲ, accounting for 55.4%. All the retinal tears were on the temporal side, hole on the temporal. Recurrence of vitreous hemorrhage appeared in 4 eyes during the two months after the treatment, accounting for 6. 15%. The follow-up observation showed that the vitreous hemorrhage were absorbed, the pigment spots around the retinal tears were even in color and the retinal tears disap- peared. Conclusions For retinal tear starting from vitreous hemorrhage in retina, the tear should be identified as soon as possible. Photocoag- ulation with 532 nm laser in edge and across the stage or in small blood vessels before vitreous body hematocele dispersed can effectively prevent the retinal detachment and vitreous hemorrhage from occurring again, which will reduce or avoid vitreous surgery.