息肉状脉络膜血管病变继发玻璃体积血的治疗及预后  

Treatment modalities and visual prognosis of polypoidal choroidal vasculopathy with breakthrough vitreous hemorrhage

作　　者：蔡晨希 王强(综述) 黄新华[1] 李涛[1] 李永浩[1] 刘炳乾[1] 林英[1] 吕林(审校)[1] CAI Chenxi;WANG Qiang;HUANG Xinhua;LI Tao;LI Yonghao;LIU Bingqian;LIN Ying;LÜLin(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060,China)

机构地区：[1]中山大学中山眼科中心,眼科学国家重点实验室,广东省眼科视觉科学重点实验室,广州510060

出　　处：《眼科学报》2022年第8期658-664,共7页Eye Science

基　　金：白求恩·朗沐中青年眼科科研基金(BJ-LM2021014J)。

摘　　要：息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是亚洲人中常见的眼底致盲性疾病,当PCV合并视网膜下出血或玻璃体积血(vitreous hemorrhage,VH)时,患者视力骤然下降,视力预后差异大。但目前聚焦于PCV合并VH的相关文献较少,因此研究和阐明PCV继发VH的治疗方法及预后具有重要的临床意义。目前临床上常选择手术干预,玻璃体切除术(pars plana vitrectomy,PPV)是临床上最常选择的一种术式。其他治疗方式包括玻璃体内注射抗血管内皮生长因子(vascular endothelial growth factor,VEGF)、眼内气体或硅油填充、眼内注射组织纤溶酶原激活剂(tissue plasminogen activator,tPA)和光动力疗法(photodynamic therapy,PDT)。PCV合并VH患者的视力预后决定因素是黄斑视功能的保留程度,也与年龄、术前视力、PCV病变部位、视网膜下出血量、视网膜脱离范围、基线黄斑中心厚度(central macular thickness,CMT)、是否出现术后并发症以及是否形成视网膜瘢痕等因素相关,目前也有研究发现视力预后与单核苷酸多态性(single nucleotide polymorphisms,SNP)相关。本文就PCV继发VH的临床特点、治疗及预后进行综述。Polypoid choroidal vasculopathy(PCV)is a common fundus blinding disease in Asians.When PCV is associated with subretinal hemorrhage or vitreous hemorrhage(VH),patient's visual acuity decreases suddenly and the visual prognosis varies greatly.There are few relevant literatures focusing on VH secondary to PCV,so it is of great clinical significance to study and clarify the treatment methods and prognosis of VH secondary to PCV.At present,surgical intervention is often selected in clinical practice.Vitrectomy is the most commonly selected surgical procedure in clinical practice.The other treatment modalities include intravitreal injection of anti-vascular endothelial growth factor(VEGF),intraocular gas or silicone oil filling,intraocular injection of tissue plasminogen activator(tPA)and photodynamic therapy.The prognostic determinant of visual acuity in PCV patients with VH is the degree of preservation of macular visual function.The prognostic is also related to age,preoperative visual acuity,PCV lesion location,amount of subretinal hemorrhage,extent of retinal detachment,baseline central macular thickness(CMT),postoperative complications and retinal scars.Recent studies also find that the prognosis of visual acuity is related to single nucleotide polymorphisms.This article reviews the clinical characteristics,treatment and visual prognosis of PCV associated with VH.

关 键 词：息肉状脉络膜血管病变 黄斑下出血 玻璃体积血 手术治疗 预后 综述 

分 类 号：R773.4[医药卫生—眼科]