296例不明原因重度玻璃体积血患者的病因及手术时机的探讨

Discussion of etiology and operative timing of 296 patients with unexplained severe vitreous hemorrhage

目的探讨排除眼外伤及糖尿病外不明原因的重度玻璃体积血的病因构成,并分析其手术时机。方法回顾性分析2018年1月至2019年1月就诊于我院的不明原因的296例(302眼)重度玻璃体积血患者的临床资料,所有患者均行术前检查及玻璃体切除术,根据术中眼底情况及部分患者术后进一步检查结果,分析其病因构成。同时根据手术时机将患者分为A组[发病<2周时手术,69例(72眼)]、B组[发病2~4周时手术,126例(127眼)]、C组[发病>4周时手术,101例(103眼)],记录三组患者术前及术后1周最佳矫正视力(BCVA),并评价手术疗效。结果患者的主要病因为视网膜静脉阻塞(RVO,51.32%),其次为视网膜裂孔和孔源性视网膜脱离(18.54%)。青年患者最常见病因为视网膜静脉周围炎,占51.32%;中年患者最常见的病因为RVO,占61.76%;老年患者最常见的病因为RVO,占66.94%。术前,各组间BCVA>0.05的患者占比比较,差异无统计学意义(P>0.05);术后1周,各组间BCVA>0.05的患者占比比较,差异有统计学意义,且A组高于B、C组(P<0.05)。结论排除眼外伤及糖尿病外的不明原因的重度玻璃体积血的主要病因为RVO,而且不同年龄段患者的主要病因不同。发现重度玻璃体积血时,应尽早明确病因,积极行玻璃体切除手术治疗。

Objective To investigate the etiological composition of severe vitreous hemorrhage with unknown causes other than ocular trauma and diabetes,and to analyze the timing of operation.Methods The clinical data of 296 patients(302 eyes)with severe vitreous hemorrhage of unknown causes admitted in our hospital from January 2018 to January 2019 were retrospectively analyzed.All patients underwent preoperative examination and vitrectomy.The etiological composition of the patients was analyzed according to the intraoperative conditions of the ocular fundus and the results of further postoperative examination of some patients.According to the timing of operation,the patients were divided into group A[operated at the time of onset<2 weeks,69 cases(72 eyes)],group B[operated at the time of onset 2-4 weeks,126 cases(127 eyes)]and group C[operated at the time of onset>4 weeks,101 cases(103 eyes)],the best corrected visual acuity(BCVA)of the three groups were recorded before operation and on 1 week after operation,and the surgical efficacy were evaluated.Results Retinal vein occlusion(RVO,51.32%)was the main etiology,followed by retinal hiatus and retinal detachment with pore origin(18.54%).The most common etiology in young patients was retinal periphlebitis,accounting for 51.32%;the most common etiology of middle-aged patients was RVO,accounting for 61.76%;the most common etiology of elderly patients was RVO,accounting for 66.94%.Before operation,there was no significant difference in the proportion of patients with BCVA>0.05 among the groups(P>0.05);on one week after operation,the proportion of patients with BCVA>0.05 in each group was statistically significant,and that in the group A was higher than the group B and C(P<0.05).Conclusion The major etiology of severe vitreous hemorrhage excluding ocular trauma and diabetes is RVO,and the main etiology of different age patients are different.When severe vitreous hemorrhage is found,the etiology should be determined as soon as possible and vitrectomy should be performed actively.