CAJ | 학술논문

目的观察玻璃体切割手术治疗息肉状脉络膜血管病变(PCV)引起的玻璃体积血的疗效.方法伴玻璃体积血的PCV患者14例14只眼纳入研究.男性8例8只眼,女性6例6只眼.平均年龄(58.7±6.0)岁.均行常规眼科检查,以及A/B型超声、荧光索眼底血管造影、吲哚青绿血管造影等检查确诊.行常规玻璃体切割手术,手术中切除玻璃体积血,手术结束时行硅油或C3F8气体填充.手术后行光动力疗法(PDT)治疗8只眼.观察患眼视网膜复位情况、视力改善状况、病变稳定程度以及手术后并发症发生情况.结果 14只眼中,治愈6只眼,占42.9％；好转7只眼,占50.0％；无效或加重1只眼,占7.1％.1次手术后视网膜复位良好10只眼.视网膜复位不良4只眼.其中,再次注入硅油后视网膜复位1只眼；再次C3F8填充后视网膜复位1只眼；下方裂孔1只眼行巩膜外垫压手术后视网膜复位；未行特殊处理1只眼,硅油维持.最终视网膜复位13只眼,占92.9％,手术后1～7 d出现前房积血5只眼,经前房冲洗或药物治疗积血吸收,眼压稳定.视力提高2行以上者1只眼,1～2行者1只眼,不变10只眼,下降2只眼.行PDT治疗的8只眼中,异常血管消退5只眼,未消退3只眼.结论对于伴玻璃体积血的PCV行玻璃体切割手术清除玻璃体积血,恢复屈光间质透明性,手术后联合PDT治疗,对稳定或提高视功能有一定的疗效.
목적 관찰파리체절할수술치료식육상맥락막혈관병변(PCV)인기적파리체적혈적료효.방법 반파리체적혈적PCV환자14례14지안납입연구.남성8례8지안,녀성6례6지안.평균년령(58.7±6.0)세.균행상규안과검사,이급A/B형초성、형광색안저혈관조영、신타청록혈관조영등검사학진.행상규파리체절할수술,수술중절제파리체적혈,수술결속시행규유혹C3F8기체전충.수술후행광동력요법(PDT)치료8지안.관찰환안시망막복위정황、시력개선상황、병변은정정도이급수술후병발증발생정황.결과 14지안중,치유6지안,점42.9％；호전7지안,점50.0％；무효혹가중1지안,점7.1％.1차수술후시망막복위량호10지안.시망막복위불량4지안.기중,재차주입규유후시망막복위1지안；재차C3F8전충후시망막복위1지안；하방렬공1지안행공막외점압수술후시망막복위；미행특수처리1지안,규유유지.최종시망막복위13지안,점92.9％,수술후1～7 d출현전방적혈5지안,경전방충세혹약물치료적혈흡수,안압은정.시력제고2행이상자1지안,1～2행자1지안,불변10지안,하강2지안.행PDT치료적8지안중,이상혈관소퇴5지안,미소퇴3지안.결론 대우반파리체적혈적PCV행파리체절할수술청제파리체적혈,회복굴광간질투명성,수술후연합PDT치료,대은정혹제고시공능유일정적료효.
Objective To observe the efficacy of vitrectomy for vitreous hemorrhage in patients with polypoidal choroidal vasculopathy (PCV).Methods Fourteen patients (14 eyes) of PCV with vitreous hemorrhage diagnosed by routine ophthalmologic examination,A and/or B mode ultrasound,fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study.The patients included eight males (eight eyes) and six females (six eyes),with the mean age of (58.7 ± 6.0)years.All patients received vitrectomy with silicone oil and C3F8 gas tamponade.There were eight eyes received photodynamic therapy (PDT) after surgery.The retinal reattachment,visual acuity,pathological lesion degree and complications were comparatively analyzed.Results Among 14 eyes,six eyes (42.9％)recovered,seven eyes (50.0％) improved,and one eye (7.1％) aggravated.Ten eyes achieved retinal reattachment after surgery,while four eyes developed retinal detachment after the first surgery.The retina remained attached in these three eyes after silicon oil tamponade,C3F8 gas tamponade and scleral buckling,respectively; but one eye maintained silicon oil without special treatment.Thirteen eyes (92.9％) achieved retinal reattachment finally.Five eyes of them occurred hyphema one to seven days after surgery,but hyphema was absorbed and intraocular pressure was stable after douche of anterior chamber and pharmacotherapy.The vision improved with more than two lines in one eyes,improved with one to two lines in one eye,unchanged in 10 eyes,and decreased in two eyes.Of eight eyes who underwent PDT,abnormal vessels regressed in five eyes,abnormal vessels remained in three eyes.Conclusions Vitrectomy can remove cloudy refracting media for PCV with vitreous hemorrhage.The combined treatment of vitrectomy and PDT can improve or stabilize visual function,is an effective therapy for the PCV with vitreous hemorrhage.