息肉状脉络膜血管病变发生大出血的危险因素和治疗进展  

Risk factors and treatment progress in massive hemorrhage secondary to polypoidal choroidal vasculopathy

作　　者：刘宝怡 马媛(综述) 李涛(审校)[1] LIU Baoyi;MA Yuan;LI Tao(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,眼病防治全国重点实验室,广东省眼科视觉科学重点实验室,广州510060

出　　处：《眼科学报》2024年第1期19-26,共8页Eye Science

基　　金：国家自然科学基金(82070972,82271093);广州市科技重点研发项目(202103000045)。

摘　　要：息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是亚洲人群中常见的致盲性眼病,发生大出血并发症后严重危害视力且预后差。PCV大出血包括视网膜下出血(subretinal hemorrhage,SRH)和玻璃体积血(vitreous hemorrhage,VH)。SRH的危险因素包括较长病程、簇型PCV、息肉状病灶不消退、合并视网膜色素上皮脱离;其治疗方式包括抗血管内皮生长因子药物、光动力疗法、激光、玻璃体腔注气、眼内注射组织纤溶酶原激活剂、玻璃体切割术或联合治疗等方式,其中,黄斑中心凹是否受累和出血时间是影响治疗方式选择的主要因素。发病年龄较大、白细胞计数较高、天门氨酸转移酶和丙氨酸转氨酶的比值较高、活化部分凝血活酶时间较长、曾行光动力疗法、有玻璃体腔注药治疗史、SRH面积大、出现视网膜色素上皮脱离的PCV患者发生VH的风险高。浓厚的VH通常需行玻璃体切割术,其手术时机和手术方式的选择是临床关注的焦点。鉴于目前PCV大出血的危险因素尚不完全明确、治疗方面也尚未形成共识,需要开展相关临床研究,提供更多依据。Polypoidal choroidal vasculopathy(PCV)is a common blinding disease in Asian populations.Massive hemorrhage complications secondary to PCV includes subretinal hemorrhage(SRH)and vitreous hemorrhage(VH).The risk factors for SRH include a long duration,clustered PCV,non-regression of polyp lesions and presented with retinal pigment epithelial detachment.The treatments for SRH including anti-vascular endothelial growth factor drugs,photodynamic therapy,laser,vitreous pneumatic displacement,intravenously injected tissue plasminogen activator,vitrectomy and combination therapy.Whether macular fovea is involved and the time since bleeding onset are the main factors affecting the choice of treatment for SRH.Older age of onset,higher white blood cell count,higher aspartate amino transferase and alanine amino transferase ratio,longer activated partial thromboplastin time retinal pigment epithelium detachment,photodynamic therapy history,intravitreal injection history larger SRH area and presented with retinal pigment epithelial detachment were associated with higher risk of VH.PCV patients with massive VH should be treated with vitrectomy,while the timing and technique of operation should be paid attention to.At present,the risk factors of PCV massive bleeding are not completedly clear,and its treatment methods are diverse,which requires a large number of studies to prove its effectiveness and establish expert diagnosis and treatment consensus.

关 键 词：息肉状脉络膜血管病变 视网膜下出血 玻璃体积血 综述 

分 类 号：R773.4[医药卫生—眼科]