高龄严重玻璃体积血患者的病因分析  

Clinical etiological analysis of severe vitreous hemorrhage in venerable age patients

作　　者：王叶楠[1] 胡运韬 马志中[3] 王常观[3] 窦宏亮[3] 冯学峰[3] 许艺民[3] 王习哲[1] Wang Yenan;Hu Yuntao;Ma Zhizhong;Wang Changguan;Dou Hongliang;Feng Xuefeng;Xu Yimin;Wang Xizhe(Department of Ophthalmology,Xuanwu Hospital Capital Medical University,Beijing 100053,China;Department of Ophthalmology,Beijing Tsinghua Chang Gung Hospital,Beijing 102218,China;Peking University Third Hospital Eye Center,Beijing 100191,China)

机构地区：[1]首都医科大学宣武医院眼科北京,100053 [2]北京清华长庚医院眼科,102218 [3]北京大学第三医院眼科,100191

出　　处：《中华实验眼科杂志》2018年第10期780-784,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：目的探讨高龄患者严重玻璃体积血的病因。方法采用回顾性系列病例观察方法，收集1999年7月至2015年6月在首都医科大学宣武医院眼科、北京大学第三医院眼科中心和北京清华长庚医院眼科诊断为严重玻璃体积血的高龄患者30例30眼的临床资料，包括视力、眼压、眼前节裂隙灯显微镜检查、扩瞳后间接检眼镜检查及眼科B型超声检查。30眼均给予玻璃体切割术（PPV）治疗。术后对患者定期随访，观察视力、眼压、眼前节及眼底情况对患者临床特点进行分析。结果30例患者中男18例，女12例；年龄80～91岁，平均（81.33±1.25）岁。扩瞳后间接检眼镜检查：30眼玻璃体浓厚积血，眼底不能窥入。视力检查：数指8眼，手动5眼，光感16眼，无光感1眼。眼部B型超声检查显示所有患眼玻璃体腔内均可见高回声密集光点或光团，完全/不完全玻璃体后脱离（PVD）；5眼不同程度视网膜脱离；3眼机化条索与球壁粘连。PPV术后证实视网膜静脉不全阻塞（RVO）10眼，占33.33%；视网膜裂孔或视网膜脱离7眼，占23.33%；息肉样脉络膜血管病变（PCV）7眼，占23.33%；增生性糖尿病视网膜病变（PDR）4眼，占13.33%，以上4种病因共28眼，占93.33%。其他为眼外伤2眼，占6.67%。结论高龄患者发生严重玻璃体积血的病因主要为RVO，其次是视网膜裂孔或视网膜脱离、PCV和PDR，眼外伤少见。PPV是诊断性治疗，可清除玻璃体积血，提高患者视力，又可明确病因。Objective To analyze the etiologies of severe vitreous hemorrhage in venerable age patients.Methods A retrospective series case study was adopted.Medical records of 30 cases 30 eyes severe vitreous hemorrhage venerable age patients were analyzed in Xuanwu Hospital Capital Medical University,Peking University Third Hospital and Beijing Tsinghua Chang Gung Hospital from July in 1999 to June in 2015.Visual acuity,intraocular pressure,anterior segment slit lamp microscopy,mydriasis funduscopy and ophthalmic B type ultrasound examination were used to evaluate 30 cases 30 eyes.Thirty eyes were all treated with pars plana vitrectomy(PPV).Results Mydriasis funduscopy examination showed that vitreous hemorrhage was so dense in 30 eyes that the fundus cannot be observed.The initial visual acuity examination showed that 8 eyes were count finger,5 eyes were hand move,16 eyes were light perception,and 1 eye was no light perception.There were dense light spots or clusters of high echoes in vitreous cavities,complete/incomplete posterior vitreous detachment(PVD)of all eyes;retinal detachment with different degrees in 5 eyes;proliferating cord adhesion to the wall of eyeball in 3 eyes.The etiologies included retinal vein occlusion(RVO)in 10 eyes(33.33%),retinal tear or retinal detachment in 7 eyes(23.33%),polypoidal choroidal vasculopathy(PCV)in 7 eyes(23.33%),proliferative diabetic retinopathy(PDR)in 4 eyes(13.33%).The above 4 etiologies were in 28 eyes,accounting for 93.33%.The others were ocular trauma in 2 eyes(6.67%).Conclusions The main cause to severe vitreous hemorrhage venerable age patients is RVO,followed by retinal tear or retinal detachment,PCV and PDR.Ocular trauma is rare.Vitrectomy is a diagnostic treatment,which can remove vitreous hemorrhage,improve the visual acuity of the patients,and determine the etiologies of the vitreous hemorrhage.

关 键 词：高龄 严重玻璃体积血 病因 玻璃体切割术 

分 类 号：R776.4[医药卫生—眼科]