视网膜血管瘤的临床疗效观察

Observation on the clinical therapeutic efficacy of retinal angiomas

目的 观察探讨视网膜血管瘤的临床治疗效果。 方法 回顾分析 16例 2 0只眼视网膜血管瘤的临床资料。 16例中 ,男 5例 ,女 11例 ,平均年龄 2 3.3岁 ;其中双眼发病者 4例 ,均属于 von Hippel-L indau(VHL )病。按照血管瘤有无明显滋养血管扩张至瘤体、周围渗出、局限性视网膜脱离、广泛视网膜脱离最终至晚期并发症的过程 ,将本病分为 5期。治疗的方法有激光、视网膜冷冻合并或不合并放液、巩膜外加压及玻璃体视网膜手术。全部病例均随访 12个月以上 ,平均随访时间 37.8个月。 结果 共有 10只眼( 期 2只眼 , 期 7只眼 , 期 1只眼 )采用激光治疗 ,激光治疗后 ,全部血管瘤均得以控制 ;其中 ,视力提高 2只眼 ,不变 4只眼 ,下降 4只眼。 7只眼 ( 期 5只眼 , 期 2只眼 )进行了冷冻治疗 ,5只眼出现视力下降 ,病情稳定的有 3只眼 (均为 期 ) ,病情进展的共 4只眼 ( 期 2只眼 , 期 2只眼 )。进行玻璃体视网膜手术的共有 4只眼 (包括激光光凝术后 2只眼 ) ,术后视力提高 2只眼 ,视力稳定 1只眼 ,视力下降 1只眼。未治疗的 1只眼随访 1.5年后进展至无光感。 4例 VHL病患者中有 3例 3只眼随访中发现了新生的视网膜血管瘤。 结论 激光治疗是 ～ 期视网膜血管瘤的有效治疗方法 ,冷冻治疗可加重眼内的渗出和增?

Objective To investigate the therapeutic effects of retinal angioma. Methods The clinical data of 16 cases(20 eyes) were retrospectively analyzed, and the patients included 5 males and 11 females of 23.3 yeras old on average. Four cases in this series affected by bilateral retinal angiomas were identified as von Hippel-Lindou disease. The retinal angiomas were divided into 5 stages according to their degrees of developmnet from simple angiom without vessel dilation to feeder vessel dilation and intraretinal exudates, local retinal detachemnt, massive retinal detachment and complication occurrence in proper order. The methods of treatment were laser photocoagulation, trans-scleral cryotherapy and vitreoretinal surgery. The patinets were followed up for 37.8 months on average. Results There were 10 eyes(2 in stage 1, 7 in stage 2, 1 in stage 3)treated with laser photocoagulation, and all of the angiomas were controlled after the treatment. The visual acuity improved in 2 eyes, decreased in 4 eyes, and remained unchanged in 4 eyes. Cryotherapy was performed on 7 eyes(5 in stage 3, 2 in stage 4). The visual deteriortion was found in 5 eyes; and the state of illness was stable in 3 eyes in stage 3 and aggravating in 4 eyes (2 in stage 3, 2 in stage 4). Vitreoretinal surgery was performed on 4 eyes including 2 which had been gi ven photocoagulation, and the visual acuity improved in 2 eyes, decreased in 1 eye, and was unimproved in 1 eye. The visual acuity decreased to no light perception in an untreated eye after 1.5-year follow-up. New angiomas occurred in 3 eyes with Von-Hippel-Lindou disease in the follow-up period. Conclusion Laser photocoagulation is effective in treating the angiomas from stage 1 to 3. Cryotherapy can cause massive exudation and proliferation, and it is only suitable for a few patients in stage 3. The visual prognosis is more favorable in vitreoretinal surgery than other therapies for the patients in stage 4.