中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2014年
10期
737-742
,共6页
丛春霞%林锦镛%王兰惠%王玉川
叢春霞%林錦鏞%王蘭惠%王玉川
총춘하%림금용%왕란혜%왕옥천
视网膜出血%视网膜脱离%破裂,自发性
視網膜齣血%視網膜脫離%破裂,自髮性
시망막출혈%시망막탈리%파렬,자발성
Retinal hemorrhage%Retinal detachment%Rupture,spontaneous
目的 总结视网膜下大量出血病变的临床和病理学特点.方法 回顾性系列病例研究.收集天津市眼科医院病理科自1988年5月至2012年4月间收检到的7例视网膜下大量出血病例的临床和病理学资料,对这些病例的眼球标本进行连续切片,采用HE染色和过碘酸雪夫染色,在光镜下重新阅片并结合患者的临床、影像学和病理学方面的特点进行分析.结果 7例患者中,男性6例,女性l例,发病年龄为60 ～ 82岁,平均为71.7岁;右眼4例,左眼3例.临床主要表现为视力突然减退或视力丧失,有2例伴有青光眼症状.眼B超检查,6例提示为后极部脉络膜肿物,1例提示视网膜脱离、玻璃体出血.彩色多普勒超声检查3例,提示脉络膜实体性占位性病变,其中2例可见血流信号.MRI检查3例,显示T1W1呈等、高信号,T2W1呈等、低信号;2例提示为脉络膜黑色素瘤,1例提示视网膜下出血.6例临床诊断考虑为脉络膜肿物或黑色素瘤,1例诊断为急性闭角型青光眼.7例患者均行眼球摘除术.病理学检查:6例诊断为玻璃体出血、视网膜色素上皮下出血性脱离和视网膜下大量出血,其中2例分别伴有继发性闭角型青光眼或开角型青光眼;相关的脉络膜病变包括:软性Bruch膜疣3例、脉络膜毛细血管壁变性2例、视网膜色素上皮下方纤维血管膜形成2例、局限性脉络膜非肉芽肿性慢性炎症4例、脉络膜血管壁增厚和硬化2例、脉络膜血管异常1例.另外1例病理诊断为视网膜大动脉瘤破裂、视网膜内和视网膜下大量出血,玻璃体出血.结论 视网膜下大量出血好发于老年男性,主要表现为视力突然下降或消失,少数患者伴有急性青光眼症状.眼B超和影像学检查的表现类似于脉络膜实体性肿物,容易误诊为脉络膜黑色素瘤.病理学检查提示视网膜下大量出血主要是由于视网膜色素上皮出血性脱离和视网膜大动脉瘤破裂所致.
目的 總結視網膜下大量齣血病變的臨床和病理學特點.方法 迴顧性繫列病例研究.收集天津市眼科醫院病理科自1988年5月至2012年4月間收檢到的7例視網膜下大量齣血病例的臨床和病理學資料,對這些病例的眼毬標本進行連續切片,採用HE染色和過碘痠雪伕染色,在光鏡下重新閱片併結閤患者的臨床、影像學和病理學方麵的特點進行分析.結果 7例患者中,男性6例,女性l例,髮病年齡為60 ～ 82歲,平均為71.7歲;右眼4例,左眼3例.臨床主要錶現為視力突然減退或視力喪失,有2例伴有青光眼癥狀.眼B超檢查,6例提示為後極部脈絡膜腫物,1例提示視網膜脫離、玻璃體齣血.綵色多普勒超聲檢查3例,提示脈絡膜實體性佔位性病變,其中2例可見血流信號.MRI檢查3例,顯示T1W1呈等、高信號,T2W1呈等、低信號;2例提示為脈絡膜黑色素瘤,1例提示視網膜下齣血.6例臨床診斷攷慮為脈絡膜腫物或黑色素瘤,1例診斷為急性閉角型青光眼.7例患者均行眼毬摘除術.病理學檢查:6例診斷為玻璃體齣血、視網膜色素上皮下齣血性脫離和視網膜下大量齣血,其中2例分彆伴有繼髮性閉角型青光眼或開角型青光眼;相關的脈絡膜病變包括:軟性Bruch膜疣3例、脈絡膜毛細血管壁變性2例、視網膜色素上皮下方纖維血管膜形成2例、跼限性脈絡膜非肉芽腫性慢性炎癥4例、脈絡膜血管壁增厚和硬化2例、脈絡膜血管異常1例.另外1例病理診斷為視網膜大動脈瘤破裂、視網膜內和視網膜下大量齣血,玻璃體齣血.結論 視網膜下大量齣血好髮于老年男性,主要錶現為視力突然下降或消失,少數患者伴有急性青光眼癥狀.眼B超和影像學檢查的錶現類似于脈絡膜實體性腫物,容易誤診為脈絡膜黑色素瘤.病理學檢查提示視網膜下大量齣血主要是由于視網膜色素上皮齣血性脫離和視網膜大動脈瘤破裂所緻.
목적 총결시망막하대량출혈병변적림상화병이학특점.방법 회고성계렬병례연구.수집천진시안과의원병이과자1988년5월지2012년4월간수검도적7례시망막하대량출혈병례적림상화병이학자료,대저사병례적안구표본진행련속절편,채용HE염색화과전산설부염색,재광경하중신열편병결합환자적림상、영상학화병이학방면적특점진행분석.결과 7례환자중,남성6례,녀성l례,발병년령위60 ～ 82세,평균위71.7세;우안4례,좌안3례.림상주요표현위시력돌연감퇴혹시력상실,유2례반유청광안증상.안B초검사,6례제시위후겁부맥락막종물,1례제시시망막탈리、파리체출혈.채색다보륵초성검사3례,제시맥락막실체성점위성병변,기중2례가견혈류신호.MRI검사3례,현시T1W1정등、고신호,T2W1정등、저신호;2례제시위맥락막흑색소류,1례제시시망막하출혈.6례림상진단고필위맥락막종물혹흑색소류,1례진단위급성폐각형청광안.7례환자균행안구적제술.병이학검사:6례진단위파리체출혈、시망막색소상피하출혈성탈리화시망막하대량출혈,기중2례분별반유계발성폐각형청광안혹개각형청광안;상관적맥락막병변포괄:연성Bruch막우3례、맥락막모세혈관벽변성2례、시망막색소상피하방섬유혈관막형성2례、국한성맥락막비육아종성만성염증4례、맥락막혈관벽증후화경화2례、맥락막혈관이상1례.령외1례병리진단위시망막대동맥류파렬、시망막내화시망막하대량출혈,파리체출혈.결론 시망막하대량출혈호발우노년남성,주요표현위시력돌연하강혹소실,소수환자반유급성청광안증상.안B초화영상학검사적표현유사우맥락막실체성종물,용역오진위맥락막흑색소류.병이학검사제시시망막하대량출혈주요시유우시망막색소상피출혈성탈리화시망막대동맥류파렬소치.
Objective To improve pathological understanding of massive sub-retinal hemorrhage.Methods Retrospective case series study.The clinical and pathological data of 7 cases of massive sub-retinal hemorrhage which were examined in the Pathological Department of Tianjin Eye Hospital from May 1988 to April 2012 were collected.The serial section of eyeball specimens were made with HE and PAS staining.The pathological section were reviewed under the light microscope.Analysis were made again combining with patients' clinical history,imaging findings and the pathological features.Results In 7 patients,6 patients were male,1 patient was female.The age range was from 60 to 82 years old and the average age was 71.7 years old.Four cases were on the right eye and 3 cases were on the left eye.The main clinical feature was sudden loss of vision and 2 cases had acute glaucoma symptoms.Ultrasound examination showed choroidal tumor in 6 cases and retinal detachment with vitreous hemorrhage in one case.The color Doppler ultrasound examination demonstrated choroidal substantive occupying lesion in 3 cases and two of them were detected with blood flow signal.The MRI were examined in 3 cases which showed iso-high signal in T1W1 and iso-low signal in T2W1 suggesting the choroidal melanoma in 2 cases and sub-retinal hemorrhage in 1 case.Six cases were diagnosed clinically as choroidal tumor or melanoma and 1 case was diagnosed as acute angle-closure glaucoma.The enucleation were performed in 7 cases.In these cases,6 cases were diagnosed pathologically as vitreous hemorrhage,hemorrhagic RPE detachment and massive subretinal hemorrhage.The related choroidal lesions included soft drusen of Bruch membrane in 3 cases,choriocapillaris wall degeneration in 2 cases,fibrovascular membrane formation under RPE in 2 cases,choroidal chronic non-granulomatous inflammation in 4 cases,choroidal vessels wall thickening and sclerosis in 2 cases and choroidal vessels anomaly in one case.The secondary angle-closure glaucoma or angle-open glaucoma were accompanied respectively in 2 cases.Another case of 7 cases was diagnosed pathologically as the rupture of retinal macroaneurysm with massive sub-retinal hemorrhage.Conclusions Massive sub-retinal hemorrhage liked to occur in the elderly male patients.The main manifestations were sudden visual loss.A small number of patients had symptoms of acute glaucoma.Ophthalmic ultrasound and imaging characteristics were usually similar to the choroidal substantive neoplasm and were easily misdiagnosed as choroidal melanoma.Pathological examination revealed that the main reasons of massive hemorrhage were from the hemorrhagic RPE detachment and the rupture of retinal macroaneurysm.
