【摘要】 目的 研究玻璃体切除术治疗视网膜静脉阻塞性玻璃体出血的疗效及其手术并发症。方法 回顾性分析1992年4月至1996年12月我院行玻璃体切除术的47例患者,并对30例进行了随访。结果 (1)80%患者视力提高,分支静脉阻塞(branch vein occlusion,BVO)组视力好于中央静脉阻塞(central vein occlusion,CVO)组,P<0.05。(2)术中并发症为医源性裂孔,术后并发症中晶体混浊、玻璃体再出血、视网膜脱离和高眼压较多见。(3)术中行眼内激光治疗的患者,玻璃体再出血发生率低,P<0.05。结论玻璃体切除术使半数以上患眼重新获得有用视力,术中行眼内激光治疗能预防术后玻璃体再出血。
Vitrectomy for vitreous hemorrhage caused by retinal vein occlusion
LIU Wei, WANG Wenji. Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical University, Shanghai 200031
【Abstract】 Objective To evaluate the efficacy and complications of vitrectomy for vitreous hemorrhage after retinal vein occlusion.Methods We retrospectively studied 47 patients (47 eyes) having undergone vitrectomy during the period from April, 1992 to December, 1996. Follow-up was made on 30 patients.Results (1) Visual acuity was improved postoperatively in 80% of the eyes. The patients with branch vein occlusion achieved more favorable final vision than those with central retinal vein occlusion (P<0.05). (2) The most common complications were lens opacity, recurrent vitreous hemorrhage, iatrogenic rhegmatogenous retinal detachment and glaucoma. (3) Patients treated with endophotocoagulation had a lower rate of recurrent vitreous hemorrhage (P<0.05).Conclusions (1) More than half of the petients can achieve ambulant vision after vitrectomy for vitrous hemorrhage induced by retinal vein occlusion. (2) Recurrent vitreous hemorrhage can be effectively prevented by endophotocoagulation during the operation.
【Key words】 Retinal vein occlusion Vitreous hemorrhage Vitrectomy
玻璃体出血是视网膜静脉阻塞的晚期并发症之一,严重影响视力,保守治疗效果不佳。近年来,我院采用玻璃体切除术治疗本病,取得一定效果,现报道如下。
资料与方法
1.一般资料:1992年4月至1996年12月我院住院患者47例(47只眼),其中男33例,女14例;右眼23只眼,左眼24只眼;年龄30~72岁,平均56.3岁。玻璃体积血病程1个月至7年(1个月即手术治疗者因另一眼视力极差),平均8.8个月。术前均行视力、裂隙灯显微镜和眼底镜检查。38例术前有B超检查结果。既往有明确的视网膜静脉阻塞史者8例,术中清除玻璃体内积血后发现有静脉阻塞者39例。按病因分组:中央静脉阻塞(central vein occlusion,CVO)组14例(14只眼),分支静脉阻塞(branch vein occlusion,BVO)组33例(33只眼)。
2.术前患眼视力:CVO组:光感5只眼,手动7只眼,指数2只眼。BVO组:光感5只眼,手动18只眼,指数6只眼,0.01~0.08者2只眼,0.1者1只眼,0.2者1只眼。术前患眼均无虹膜红变。有轻度晶体混浊者21只眼,慢性闭角型青光眼1只眼,B超发现牵引性视网膜脱离者3只眼。
3.玻璃体手术方法:采用局麻。经睫状体平坦部行三切口玻璃体切除术,清除玻璃体内积血。有视网膜前积血者用笛针吸除。压迫巩膜,清除周边部积血。如有视网膜前膜,则用钩、镊尽量剥除,有新生血管及血管闭塞处行眼内激光治疗(1994年后),术中发现有视网膜裂孔用激光(1994年后)或冷冻处理。合并视网膜脱离者行外加压或环扎。必要时向玻璃体腔内注入空气、C3F8气体或行硅油眼内填充。
4.随访:47例中随访到30例,随访期1~62个月,平均20.8个月。其中随访1年以上者21例。
结果
1.术后视力:本组47只眼,出院时40只眼(85.1%)视力提高,5只眼视力与术前相同,2只眼视力较术前下降。随访30例中,24只眼(80.0%)视力较术前提高,6只眼(20.0%)视力下降或不变。 CVO组随访8例,其中5只眼(62.5%)视力≥0.01,2只眼(25.0%)视力为0.1。BVO组随访22例,其中15只眼(68.2%)视力≥0.01,11只眼(50.0%)视力≥0.1,有2只眼最佳视力为0.8。BVO组视力恢复好于CVO组,两组间比较采用秩和检验,u值=1.962(P<0.05)。
2.手术并发症:(1)术中并发症:医源性裂孔5只眼。(2)术后早期并发症:术后1个月内发生晶体混浊或加重8只眼, 玻璃体再出血6只眼,视网膜脱离5只眼,眼压升高3只眼,角膜上皮延迟愈合2只眼,前房积血1只眼,中风1例。(3)术后晚期并发症:随访患者中发生晶体混浊或加重16只眼,高眼压2只眼,玻璃体再出血2只眼,视网膜脱离2只眼,黄斑前膜1只眼,硅胶脱出1只眼。
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