视网膜血管炎光凝及玻切疗效观察

Observation of the Effect of the Photocoagulation and Vitrectomy Treatment on Eales Disease

目的 应用眼底血管造影结果及视力判定单纯光凝及玻切加眼内光凝治疗特发性视网膜血管炎 (Eales病 )的疗效。方法 回顾性分析单纯光凝 67眼及 3 1眼玻切加光凝者治疗前后眼底荧光血管造影及视力的变化。结果 光凝组无灌注区消退3 1眼 ( 5 5 4% )、改善 17眼 ( 3 0 4% )、不变 4眼 ( 7 1% )、恶化 4眼 ( 7 1% ) ;新生血管消退 3 0眼 ( 5 0 8% )、改善 19眼 ( 3 2 2 % )、不变 6眼( 10 2 % )、恶化 4眼 ( 6 8% )。术后第一次造影 ,光凝组 2 5眼存在无灌注 ,玻切组仅 2眼 ;光凝组 2 9眼存在新生血管 ,玻切组为 3眼。手术前、后最佳矫正视力≥ 0 3者光凝组分别为 3 0眼、47眼 ,玻切组为 0眼和 5眼 ;≥ 0 0 5者光凝组分别为 5 4眼、60眼 ,玻切组为11眼、2 0眼。结论 玻切后眼底造影情况较好与眼内光凝较充分有关 ,玻切后残眼数多与大量积血或网脱对黄斑部的损伤以及玻切手术对黄斑部损害有关。故对Eales病患者应早期行眼底造影检查 ,一旦发现有激光治疗指征 ,应尽早治疗 ;治疗后应复查造影、补充治疗 。

Objective To evaluate the effect of argon laser photocoagulation (photocoagulation group) and endolaser photocoagulation during vitrectomy (vitrectomy group) on the eyes with Eales disease by fundus fluorescein angiography(FFA) and visual acuity (VA).Methods Sixty-seven eyes with Eales were treated by photocoagulation and 31 eyes with Eales were treated by vitrectomy. The changes of FFA and VA before and after treatment were observed.Results In the photocoagulation group, retinal non-perfusion disappeared in 31eyes(55 4%),alleviated in 17eyes(30 4%),unchanged in four eyes(7 1%)and deteriorated in four eyes(7 1%).Retinal neovascularization disappeared in 30 eyes(50 8%),alleviated in 19 eyes (32 2%),remained in six eyes(10 2%)and deteriorated in four eyes(6 8%).The first FFA after treatment, non-perfusion was existed in 25 eyes in photocoagulation group, and only was existed in two eyes in vitrectomy group.Neovascularization was existed in 29 eyes in photocoagulation group, and was existed in three eyes in vitrectomy group.The best visual correction(VA≥3 0) in photocoagulation and vitrectomy groups respectively was 30 eyes and zero eye before treatment,and after treatment respectively was 47 eyes and five eyes.There were 54 eyes and 11 eyes with VA≥0 05 in photocoagulation and vitrectomy groups respectively before treatment,and 60 eyes and 20 eyes with VA≥0 5 respectively after treatment.Conclusions The better result of FFA in vitrectomy group was related to the sufficient photocoagulation by endolaser. The higher rate of low vision in vitrectomy group was related to the impairment of macula by large amount of vitreous hemorrhages,retina detachment and vitrectomy. So the patients with Eales should be checked by FFA as early as possible.If the patients had the indicator to be treated by laser,they should be treated early and rechecked by FFA,to avoid the visual function harm by repeated vitreous hemorrhage due to incomplete treatment.