病理性近视不同机制黄斑出血的临床观察

Different macular hemorrhage in pathological myopia: clinical characteristics and visual outcome

目的探讨病理性近视不同机制黄斑出血的临床特点和视力预后。方法回顾性分析我院2015年1月~2017年12月收治的高度近视黄斑部出血患者,随访至少3个月。所有患者均用眼底、血管造影和光学相干层析成像评估黄斑出血的病因。比较有脉络膜新生血管(CNV)患者和无CNV患者的最佳矫正视力(BCVA)、眼压(IOP)、年龄、性别、屈光度和眼底特征。结果共纳入患者33例,其中CNV患者18例行玻璃体内注射抗血管内皮生长因子(VEGF)治疗,15例无CNV的患者保守治疗。CNV组年龄明显高于非CNV组(P<0.05)。非CNV组漆裂纹更常见,而CNV组Fuchs斑和脉络膜视网膜萎缩更常见,2组间的性别、屈光度、眼压差异无统计学意义。3个月后,2组视力均明显改善,但改善幅度差异无统计学意义。结论高度近视的CNV黄斑出血者较无CNV者年龄大,且常合并Fuchs斑和脉络膜视网膜萎缩。CNV出血抗VEGF治疗或非CNV出血保守治疗均有明显的视力改善。

Objective To evaluate the clinical characteristics and visual outcome of different macular hemorrhage in pathological myopia.Methods We conducted a retrospective study of 33 pathological myopia patients with macular hemorrhage and followed them for at least 3 months from Jan.2015 to Dec.2017.All patients were evaluated with fundus,angiography and optical coherence tomography to detect the underlying cause of macular hemorrhage.Best corrected visual acuity(BCVA),intraocular pressure(IOP),age,sex,refractory error,and characteristics of fundus were compared between patients with choroidal neovascularization(CNV)and without CNV.Results A total of 33 patients were reviewed.Eighteen patients with CNV were treated with intravitreal anti-vascular endothelial growth factor(VEGF).Fifteen patients without CNV were given conservative therapy.The CNV group was significantly older than the non-CNV group(P<0.05).Fuchs spot and chorioretinal atrophy were more frequently detected in CNV group.Lacquer crack were more frequently detected in non-CNV group.There was no significant difference in sex,refractory error,IOP between the two groups.After 3 months,the visual acuity significantly improved in both groups.Conclusions The age of macular hemorrhage with CNV in pathological myopia is older than that without CNV,and the former were more often detected Fuchs spot and chorioretinal atrophy.Visual acuity improvement was found in both anti-VEGF treated CNV group and conservative therapy treated non-CNV group.