自发性视网膜下大量出血七例的临床和病理学观察  

Clinical and pathological observation of seven cases of spontaneous sub-retinal hemorrhage

作　　者：丛春霞[1] 林锦镛[1] 王兰惠[1] 王玉川[1] 

机构地区：[1]天津市眼科医院天津市眼科学与视觉科学重点实验室天津市眼科研究所天津医科大学眼科临床学院,300020

出　　处：《中华眼科杂志》2014年第10期737-742,共6页Chinese Journal of Ophthalmology

摘　　要：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.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＆#39; 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 ac

关 键 词：视网膜出血 视网膜脱离 破裂 自发性 

分 类 号：R774.1[医药卫生—眼科]