老年性黄斑变性视网膜下伴玻璃体积血的临床分析

THE CLINICAL FEATURE OF SUBRETINAL AND VITREOUS HEMORRHAGE ASSOCIATED WITH SENILE MACULAR DEGENERATION

探讨老年性黄斑变性视网膜下积血伴玻璃体积血患者的临床特点及手术效果。老年性黄斑病变视网膜下积血伴玻璃体积血患者 2 9例 ,均采用玻璃体切除的方法治疗 ,术中观察其特点 ,并对手术效果进行分析。结果显示 ,黄斑下积血 16例 ,其中 4例伴有黄斑旁视网膜下积血 ;单纯黄斑旁视网膜下积血 13例 ;黄斑区表现为盘状变性、黄斑下新生血管、局部增殖、固定皱褶 ,渗出、瘢痕及萎缩灶盘状瘢痕等 ;玻璃体切除术后患者视力均有不同程度的提高 ;黄斑旁视网膜下积血的术后视力提高较黄斑下出血者高。研究表明 ,老年性黄斑变性视网膜下伴玻璃体积血者黄斑病变比较重 ,玻璃体切除手术治疗有一定的效果 。

To study the clinical feature and surgical outcome of subretina and vitreous hemorrhage associated with senile macular degeneration (SMD). Vitrectomy was performed in 29 eyes of 29 patients with subretina and vitreous hemorrhage associated with SMD. Changes in the retina were observed, and the results of surgery were analyzed. The results showed that there was submacular hemorrhage in 16 patients, in whom 4 showed periomacular subretinal hematoma. There was peri macular subretinal hematoma only in 13 cases. The pathological changes in the macular region included discoid degeneration, submacular neovascularization, fixed foldings, exudation, scar and atrophic discoid cicatrization. All patients got visual acuity improvement after surgery. However those patients who had subretinal hemorrhage got less improvement of visual acuity than the others. It suggested that the SMD patients who was complicated by subretinal hemorrhage had a severer macular lesion. Pars plana vitrectomy could restore central vision of patients who suffered from subretinal and vitreous hemorrhage. But the outcome was related with the position of subretinal hemorrhage.