大量出血型息肉状脉络膜血管病变行重水辅助下玻璃体切除联合巩膜外引流术的疗效  

Efficacy analysis of deuterium oxide-assisted vitrectomy combined with external scleral drainage for massive sub-macular hemorrhage in polypoidal choroidal vasculopathy

作　　者：江恒 骆泓波 郑青青[1] 郦晓霞 刘辉[1] JIANG Heng;LUO Hongbo;ZHENG Qingqing;LI Xiaoxia;LIU Hui(Department of Ophthalmology,Zhejiang Provincial People’s Hospital,People’s Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院眼科,浙江杭州310014

出　　处：《温州医科大学学报》2024年第1期36-41,共6页Journal of Wenzhou Medical University

基　　金：浙江省中医药科技计划项目(2016ZA033);浙江省医药卫生科技计划项目(2018RC018)。

摘　　要：目的:探讨息肉状脉络膜血管病变(PCV)引起黄斑下大量出血行重水辅助下玻璃体切除联合巩膜外引流术的临床疗效。方法:回顾性分析2017年1月至2022年1月在浙江省人民医院行玻璃体切除术的出血型PCV患者56例(56眼)。根据是否联合重水辅助下的巩膜外引流手术,将其分为单纯玻切组(28眼)与联合治疗组(28眼)。观察两组治疗前后的最佳矫正视力、黄斑中心凹视网膜厚度(CMT)、息肉样血管病灶消退情况,同时记录治疗期间两组并发症情况。结果:联合治疗组在治疗后第1个月、第3个月、第6个月和第12个月时的视力较基线均有所提高(均P<0.05);而单纯玻切组在第1个月和第3个月的视力较基线下降(P<0.05),直至6个月和12个月才显著上升(P<0.05);联合治疗组在治疗后第1个月、第3个月、第6个月和第12个月时的视力均优于单纯玻切组(均P<0.05)。联合治疗组和单纯玻切组在治疗后第1个月、3个月、6个月和12个月的CMT较基线均显著下降(均P<0.05);在治疗后第1个月、第3个月、第6个月和第12个月,联合治疗组的CMT均低于单纯玻切组(均为P<0.05)。治疗后6个月时,联合治疗组4例患者息肉样血管病灶基本消退,单纯玻切组1例息肉样血管病灶基本消退,两组间比较差异无统计学意义(P=0.349)。治疗后第12个月时,联合治疗组8例患者息肉样血管病灶完全消退,单纯玻切组4例息肉样血管病灶消退,两组间比较差异无统计学意义(P=0.193)。治疗期间联合治疗组未出现明显并发症;单纯玻切组有10例出现并发症,治疗后得以控制。结论:重水辅助下玻璃体切除联合巩膜外引流手术相对单纯玻璃体切除术能更有效地改善患者视力,更显著地降低出血型PCV患者的CMT,出血引流更为彻底,术后黄斑下积血更少,术后并发症更少。Objective:To investigate the clinical efficacy of deuterium oxide-assisted vitrectomy combined with external scleral drainage for massive sub-macular hemorrhage caused by polypoidal choroidal vasculopathy(PCV).Methods:Retrospective analysis was performed in the hemorrhagic PCV patients with vitrectomy from Zhejiang Provincial People's Hospital between January 2017 and 2022.Patients were divided into two groups:vitrectomy alone(28 eyes) and deuterium oxide-assisted vitrectomy combined with external scleral drainage surgery(28 eyes).The best-corrected visual acuity(BCVA),centre macular thickness(CMT),regression of polypoid vascular lesions and complications were observed pre-and post-operation in both groups.Results:The BCVA of the combined group improved after treatment compared with the baseline at the 1st,3rd,6th and 12th months(P<0.05),while the BCVA of the single vitrectomy group decreased compared with pre-operation at the 1st and 3rd months post-operation(P<0.05),and it increased significantly at the 6th and 12th months post-operation(P<0.05).The BCVA of the combined group was all better than that of the single vitrectomy group at the 1st,3rd,6th and 12th months post-operation(P<0.05).CMT of the combined group and the single vitrectomy group all decreased significantly compared with the pre-operation at the 1st,3rd,6th and 12th months post-operation(P<0.05).And the CMT of the combined group were all lower than that of the single vitrectomy group at every follow-up point(P< 0.05).At 6th months post-operation,polypoid vascular lesion had basically regressed in 4patients in the combined group,only one polypoid vascular lesion in the single vitrectomy group had regressed significantly,and no statistical difference existed between the two groups(P=0.349).At 12th months postoperation,polypoid vascular lesion had completely regressed in 8 patients in the combined group,4 polypoid vascular lesions had regressed in the single vitrectomy group,and had no statistical difference between the two groups(P=0.193).Anterior

关 键 词：息肉状脉络膜血管病变 玻璃体切除手术 重水 巩膜外引流 

分 类 号：R749[医药卫生—神经病学与精神病学]