摘要
目的探讨老年性黄斑变性（AMD）伴玻璃体积血的诊断，观察单纯玻璃体切割治疗玻璃体积血对AMD的治疗效果。方法回顾分析10例渗出型AMD并发大量玻璃体积血住院行玻璃体切割手术治疗患者的临床资料。患者平均年龄63岁。3例患者患眼或对侧眼曾有黄斑玻璃疣或黄斑出血。9例患者视力为光感或手动。结果10例患者B型超声检查除玻璃体内光点外，后极眼底前都见列一条光带，光带下有点状高回声；4例患者同时在下方探查到有高回声的局限性视网膜隆起。手术中发现视网膜及视网膜色素上皮下大片出血，范围占1／2至4／5眼底，出血量大时可隆起。5例患者黄斑区见到黄色扁平、拟为新生血管膜的病变。手术仅作玻璃体切割。手术后随访时视网膜下出血吸收，原拟为新生血管膜的病变成为黄白色瘢痕。视力数指～0．3。无一例再发出血。结论渗出型AMD并发玻璃体积血患者B型超声显示后极或下方的视网膜脱离光带伴高回声光点为其特征性改变，单纯玻璃体手术可提高患眼视力。新生血管膜在大量出血后形成瘢痕，病情转向稳定。
Objective To evaluate the diagnosis of vitreous hemorrhage induced by age-related macular degeneration （AMD） and the therapeutic effect of vitrectomy. Methods The clinical data of 10 inpatients with the average age of 63 years who had undergone vitrectomy because of vitreous hemorrhage caused by exudative AMD were retrospectively analyzed. Three patients had the history of macular hemorrhage or drusen in the affected or contralateral eye. The visual acuity was light perception to hand move in 9 eyes. Only 7 patients were followed up for 3 months to 3 years （average 18 months）. Results The results of B scanning showed that in addition to the light spots in the vitreous cavity, a band of reflection before the posterior pole with dense echoes beneath was detected in all eyes, and localized elevated retina with strong echoes beneath was detected simultaneously in 4 eyes. During the operation, massive subretinal and sub-RPE hemorrhage occupying 1/2 to 4/5 of the ocular fundus was found. A mass of hemorrhages led to retinal elevation. A yellowish flat lesion which was suspicious of CNV was observed in macular area in 5 patients. Only vitrectomy was perfomed. During the follow-up period, subretinal hemorrhage was absorbed and the suspicious CNV became a white scar tissue. The visual acuity of the 7 patients who had been followed up was counting finger to 0. 3, and no recurrence of hemorrhage was found. Conclusion The diagnosis of exudative AMD with vitreous hemorrhage according to the results of B-scanning examination which showed a band of reflection with strong echoes should be differentiated from the diagnosis of choroidal melanoma. Simple vitrectomy can improve the visual acuity. Subretinal CNV may evolve into a scar tissue with ceasing of the disease process after massive hemorrhage.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2007年第1期42-44,共3页
Chinese Journal of Ocular Fundus Diseases
