视乳头及其周围视网膜下出血的临床特征  

Clinical characteristics and pathogenesis of intrapapillary hemorrhage with adjacent peripapiilary subretinal hemorrhage

作　　者：滕岩[1] 于旭辉[1] 董丽[1] 滕羽菲[1] 苏颖[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院眼科,150001

出　　处：《中华眼科杂志》2012年第2期131-136,共6页Chinese Journal of Ophthalmology

摘　　要：目的 探讨视乳头及其周围视网膜下出血的临床特征及其发生机制.方法 回顾性病例系列研究.对8例（8只眼）视乳头及其周围视网膜下出血患者的临床资料进行回顾性分析,包括患者一般临床资料和视野、B超、彩色眼底照相、荧光素眼底血管造影、CT、时域和频域相干光断层扫描（OCT）检查情况,分析患者发生出血的可能机制.结果 视乳头及其周围视网膜下出血患者眼底表现为视乳头倾斜,鼻侧或上方盘沿隆起,视乳头小；鼻侧视乳头边缘和（或）视杯出血可直达玻璃体和（或）蔓延至视乳头表面、视网膜浅层；视网膜下出血均位于视乳头鼻侧和上、下方.OCT检查显示神经组织隆起,视乳头鼻侧和上方抬高,视乳头鼻侧视网膜下间隙增宽,后巩膜孔鼻侧上下方边缘锐利,颞侧钝圆.CT检查显示视神经增粗.结论 视乳头及其周围视网膜下出血患者具有典型的眼底出血特征.出血可能系睫状后短动脉穿过巩膜窗鼻侧的Elschnig边缘组织时所致.Objective To study the clinical characteristics and pathogenesis of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage （IHAPSH）.Methods A retrospective review of 8 patients with IHAPSH.The demographical data of the patients,the symptoms,initial and final visual acuities,biomicroscopic findings,fundus photographs,and the results of various special examinations,including fluoresce in angiography,B-scan ultrasonography,optical coherence tomography （OCT） and CT were analyzed.Results Fundus examination of 8 patients showed various changes of optic disc,including：a small and tilted optic disc with elevation and blurring of the nasal or superonasal edge.Hemorrhage of the optic disc was present in the cup and/or on the nasal edge,extended to the surface of the optic disc,the superficial layer of the retina and the subretinal space.Subretinal hemorrhage was located on the nasal,superior and inferior side of the optic disc.OCT examination showed an elevated optic nerve head with an enlarged nasal peripapillary subretinal space.Conclusions In the IHAPSH patient,bleeding may originate from the posterior ciliary artery that traverse the sclera window of the disc,passes through the space between the optic nerve and the scleral canal,reaches the edge of the optic disc and the subretinal space,penetrates into the optic nerve tissues anterior to the lamina cribrosa,reaches the optic cup and extends to the surface of the optic disc,the retina or the vitreous.

关 键 词：视神经 视网膜出血 荧光素血管造影术 玻璃体出血 体层摄影术 光学相干 

分 类 号：R774.1[医药卫生—眼科]