CAJ | 학술논문

目的探讨息肉状脉络膜血管病变(PCV)合并玻璃体积血的病例行玻璃体切除术联合雷珠单抗注射的疗效.方法收集2013年1月至2014年6月在深圳市眼科医院就诊的玻璃体积血患者,既往或术后经荧光素眼底血管造影及吲哚青绿血管造影确诊为PCV共15例15只眼.所有病例均采用23G全玻璃体切除术,术毕玻璃体腔注射雷珠单抗0.5 mg/0.05 ml,其中4只眼伴有出血性视网膜脱离行硅油填充,1只眼因视网膜下巨大血肿行视网膜切开彻底冲洗视网膜下积血并填充硅油.观察手术并发症、术后视力、术后再出血情况、中心凹视网膜厚度变化.结果所有病例无手术并发症发生.至随访6～15个月后,15只眼视网膜均复位良好,其中视力提高13只眼,视力不变2只眼,视力未提高的原因为后极部广泛视网膜下出血及黄斑区瘢痕形成.术后再出血2只眼,经保守治疗后吸收.术后1个月平均中心凹视网膜厚度比术后1周明显减少,差异有统计学意义(t =4.628,P=0.001).结论玻璃体切除术联合雷珠单抗注射治疗PCV合并玻璃体积血可减少术后再出血及中心凹视网膜厚度,改善视力.最终视力预后与病灶所处部位及视网膜下出血范围密切相关.
목적 탐토식육상맥락막혈관병변(PCV)합병파리체적혈적병례행파리체절제술연합뢰주단항주사적료효.방법 수집2013년1월지2014년6월재심수시안과의원취진적파리체적혈환자,기왕혹술후경형광소안저혈관조영급신타청록혈관조영학진위PCV공15례15지안.소유병례균채용23G전파리체절제술,술필파리체강주사뢰주단항0.5 mg/0.05 ml,기중4지안반유출혈성시망막탈리행규유전충,1지안인시망막하거대혈종행시망막절개철저충세시망막하적혈병전충규유.관찰수술병발증、술후시력、술후재출혈정황、중심요시망막후도변화.결과 소유병례무수술병발증발생.지수방6～15개월후,15지안시망막균복위량호,기중시력제고13지안,시력불변2지안,시력미제고적원인위후겁부엄범시망막하출혈급황반구반흔형성.술후재출혈2지안,경보수치료후흡수.술후1개월평균중심요시망막후도비술후1주명현감소,차이유통계학의의(t =4.628,P=0.001).결론 파리체절제술연합뢰주단항주사치료PCV합병파리체적혈가감소술후재출혈급중심요시망막후도,개선시력.최종시력예후여병조소처부위급시망막하출혈범위밀절상관.
Objective To investigate the therapeutic effect of intravitreal injection of ranibizumab (IVR) in pars plana vitrectomy (PPV) on eyes with polypoidal choroidal vasculopathy (PCV) and vitreous hemorrhage.Methods From January 2013 to June 2014,15 eyes of 15 patients with vitreous hemorrhage and diagnosed as PCV by FFA and ICGA were collected.All patients underwent 23G PPV with IVR (0.5mg/0.05ml) at the end of the operation.Silicon oil tamponade was applied on 4 eyes with hemorrhagic retinal detachment.Retinotomy,elimination of the subretinal hematocele and silicone oil tamponade were performed on 1 eye.Surgical complications,visual acuity (VA),recurrence of vitreous hemorrhage and retinal thickness of the fovea were recorded and analyzed.Results No surgical complication was found in any cases.Retinal attachment was achieved in all 15 eyes at the last follow-up visit.VA improvement was observed in 13 eyes,while postoperative VA maintained unchanged in the other 2 eyes.Widespread subretinal hemorrhage and scar formation in the macula accounted for the poor postoperative VA.Recurrence of vitreous hemorrhage after PPV was observed in 2 eyes,which was alleviated after conservative treatment.The average retinal thickness of the fovea was significantly decreased in 1 month after treatment,comparing with that in 1 week after surgery (t =4.628,P =0.001).Conclusions The combination of IVR and PPV can decrease the possibility of recurrent bleeding and the retinal thickness of the fovea,leading to improvement of the postoperative VA.Ultimate VA outcome is closely related to the location of the lesion and the range of subretinal hemorrhage.