目的:分析首发症状为玻璃体积血的视网膜裂孔的激光治疗临床效果。方法:回顾性分析我院于2015年6月~2017年3月就诊的首发症状为玻璃体积血的患者32例32眼,经三面镜检查证实为视网膜裂孔所致,行视网膜激光治疗,其中因玻璃体积血难以窥见眼底者,先给予药物治疗待积血吸收证实为视网膜裂孔所致者再行视网膜激光治疗。结果:随诊观察3个月,29例29眼玻璃体积血吸收,3例3眼因视网膜血管呈桥样位于裂孔上,血管再次受到牵拉破裂出血难以完成激光治疗,行玻璃体切割术,术后视网膜裂孔均封闭,随诊3个月无复发。结论:视网膜激光是治疗视网膜裂孔合并玻璃体积血的有效方法,但要注意视网膜裂孔的位置及形态。 Objective: To analyze the clinical effect of laser therapy on retinal hiatus with vitreous hematoma as the first symptom. Methods: Retrospective analysis in June 2015-March 2017 visits the first symptoms of 32 cases (32 eyes of vitreous hemorrhage patients, the three sides to verify actually caused by the retina in microscopy, laser treatment of retinal, among them with vitreous hemorrhage is difficult to see the fundus, first has been given medication to hemorrhage absorption for the retina in any laser treatment of retinal diseases shall be considered. Results: After 3 months of follow-up observation, 29 cases of vitreous hemopharmaceutic absorption occurred in 29 eyes, and 3 cases and 3 eyes were unable to complete laser treatment due to retinal blood vessels located in the hiatus as bridglike, and the blood vessels suffered from rupture and hemorrhage by pulling again. Vitrectomy was performed, retinal holes were all closed after surgery, and no recurrence was found in 3 months of follow-up examination. Conclusion: Retinal laser is an effective method to treat retinal hiatus complicated with vitreous hemorrhage, but the location and shape of retinal hiatus should be paid attention to.
目的:分析首发症状为玻璃体积血的视网膜裂孔的激光治疗临床效果。方法:回顾性分析我院于2015年6月~2017年3月就诊的首发症状为玻璃体积血的患者32例32眼,经三面镜检查证实为视网膜裂孔所致,行视网膜激光治疗,其中因玻璃体积血难以窥见眼底者,先给予药物治疗待积血吸收证实为视网膜裂孔所致者再行视网膜激光治疗。结果:随诊观察3个月,29例29眼玻璃体积血吸收,3例3眼因视网膜血管呈桥样位于裂孔上,血管再次受到牵拉破裂出血难以完成激光治疗,行玻璃体切割术,术后视网膜裂孔均封闭,随诊3个月无复发。结论:视网膜激光是治疗视网膜裂孔合并玻璃体积血的有效方法,但要注意视网膜裂孔的位置及形态。
激光,玻璃体积血,视网膜裂孔
Xueyong Wang*, Xumei Wang
Junan Guangming Eye Hospital, Linyi Shandong
Received: Aug. 13th, 2020; accepted: Aug. 27th, 2020; published: Sep. 3rd, 2020
Objective: To analyze the clinical effect of laser therapy on retinal hiatus with vitreous hematoma as the first symptom. Methods: Retrospective analysis in June 2015-March 2017 visits the first symptoms of 32 cases (32 eyes of vitreous hemorrhage patients, the three sides to verify actually caused by the retina in microscopy, laser treatment of retinal, among them with vitreous hemorrhage is difficult to see the fundus, first has been given medication to hemorrhage absorption for the retina in any laser treatment of retinal diseases shall be considered. Results: After 3 months of follow-up observation, 29 cases of vitreous hemopharmaceutic absorption occurred in 29 eyes, and 3 cases and 3 eyes were unable to complete laser treatment due to retinal blood vessels located in the hiatus as bridglike, and the blood vessels suffered from rupture and hemorrhage by pulling again. Vitrectomy was performed, retinal holes were all closed after surgery, and no recurrence was found in 3 months of follow-up examination. Conclusion: Retinal laser is an effective method to treat retinal hiatus complicated with vitreous hemorrhage, but the location and shape of retinal hiatus should be paid attention to.
Keywords:Laser, Vitreous Hemorrhage, Retinal Hiatus
Copyright © 2020 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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玻璃体积血多因眼内血管性疾病和损伤引起,也可由玻璃体后脱离、视网膜裂孔以及全身性疾病引起 [
回顾性分析我院于2015年6月~2017年3月就诊的首发症状为玻璃体积血的患者,每一位玻璃体积血患者均行扩瞳下三面镜检查详细查找视网膜裂孔并记录其位置,形态,大小。
玻璃体积血合并视网膜裂孔患者32例32眼,就诊时间为4小时~15天。其中男性20例20只眼,女性12例12只眼。年龄18~73岁。视力(国际标准对数视力表):手动者1例1眼,0.05~0.1者11例11眼,0.1~0.3者17例17眼,0.3~0.5者3例3眼。格子样变性伴裂孔者29例29眼,位于视网膜血管处裂孔者3例3眼。颞上象限者16例16眼,颞下象限者9例9眼,鼻上象限者6例6眼,鼻下象限者1例1眼。本研究获得莒南光明眼科医院伦理委员会通过。
患者就诊后均扩瞳后三面镜检查确定视网膜裂孔的位置和形态,因部分眼底被玻璃体积血遮挡,行患眼B超检查排除视网膜脱离。
治疗的目的是用激光光凝视网膜裂孔周围,使脉络膜和视网膜之间产生牢固的粘连,封闭视网膜裂孔。
对玻璃体积血未遮挡视网膜裂孔者行视网膜激光治疗,采用蔡司多波长激光治疗,波长532 nm,光凝斑直径200 m,能量90~300 mw,围绕视网膜裂孔行3排~4排激光,光斑间隔0.5个光斑直径,视网膜烧灼强度为中度,既脉络膜视网膜呈浑浊、污白色的光凝斑 [
对玻璃体积血影响视网膜激光治疗者,采取半卧位,活血化瘀药物治疗,待能看清视网膜裂孔后行视网膜激光治疗。
随诊:1周,2周,8周,12周随访,扩瞳后三面镜检查,患眼B超检查玻璃体和视网膜,是否出现视网膜牵拉和脱离声像。
29例29眼玻璃体积血吸收,视网膜裂孔封闭,视力较前提高,眼前黑影消失。视力0.3~0.5者23例23眼,0.5~0.8者5例7眼,1.0者1例1眼。3例因视网膜裂孔上方有血管牵拉,致玻璃体积血加重行玻璃体切割术治疗。视网膜激光治疗有效率达90.1%。
玻璃体本身没有血管,其积血的病因众多,其中视网膜裂孔和视网膜脱离占玻璃体积血的12%~17%。我们要了解伴玻璃体积血的视网膜裂孔的特点,才会有的放矢 [
王学勇,王绪梅. 首发症状为玻璃体积血的视网膜裂孔激光治疗临床效果The First Symptom Was the Clinical Effect of Laser Treatment of Retinal Hiatus with Vitreous Hematoma[J]. 眼科学, 2020, 09(03): 179-181. https://doi.org/10.12677/HJO.2020.93023