Dhingra Narendra, Pearce Ian, Wong David
Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK.
Graefes Arch Clin Exp Ophthalmol. 2007 Feb;245(2):301-4. doi: 10.1007/s00417-006-0278-6.
Published literature on the management of patients with fundus-obscuring dense vitreous haemorrhage due to presumptive retinal tears is sparse and advocates waiting for spontaneous resolution. Surgery is indicated only when a definite retinal tear or retinal detachment is identified.
A retrospective review of all patients who underwent early vitrectomy for vitreous haemorrhage associated with posterior vitreous detachment was carried out. A comparison of initial visual acuity versus final visual acuity after vitrectomy was performed. The number of eyes that were found to have retinal tears and retinal detachment were documented. Initial and final Snellen acuities were used for statistical analysis. Categorical data were analysed using Fisher's exact test and statistical significance was considered to be p < 0.05.
Sixteen eyes were identified and all these patients presented or were referred soon after the onset of vitreous haemorrhage. Associated ocular pathology (choroidal neovascular membrane, retinal branch vein occlu-sion, macroaneurysm) was suspected to be the source of the haemorrhage in 4 eyes. Vitrectomy was carried out in 12 eyes soon after presentation (mean time 6.3 days, range 1-28 days). Nineteen retinal breaks were seen in these eyes and 5 eyes had more than two breaks. None of the eyes were found to have proliferative vitreoretinopathy at the time of surgery. Two eyes needed repeat surgery for new retinal breaks. Excluding the eyes found to have an ocular pathology as the cause of vitreous haemorrhage, the mean visual acuity improved from hand movements to 6/12 (p < 0.001).
Early vitrectomy for spontaneous dense fundus-obscuring vitreous haemorrhage and posterior vitreous detachment is safe. Since the number of patients in this study was small, a prospective randomised controlled study comparing early versus late vitrectomy is needed to see whether early surgery also prevents proliferative vitreoretinopathy formation.
关于因疑似视网膜裂孔导致眼底模糊的致密玻璃体出血患者的治疗，已发表的文献较少，且主张等待自行吸收。仅在确定存在明确的视网膜裂孔或视网膜脱离时才考虑手术。
对所有因玻璃体出血合并玻璃体后脱离而接受早期玻璃体切除术的患者进行回顾性研究。比较玻璃体切除术前的初始视力与最终视力。记录发现有视网膜裂孔和视网膜脱离的眼数。使用初始和最终的斯内伦视力进行统计分析。分类数据采用费舍尔精确检验进行分析，统计学显著性设定为p < 0.05。
共纳入16只眼，所有这些患者在玻璃体出血发作后不久即就诊或被转诊。4只眼怀疑相关眼部病变（脉络膜新生血管膜、视网膜分支静脉阻塞、大动脉瘤）为出血来源。12只眼在就诊后不久（平均时间6.3天，范围1 - 28天）进行了玻璃体切除术。这些眼中发现了19个视网膜裂孔，5只眼有两个以上裂孔。手术时未发现任何一只眼有增殖性玻璃体视网膜病变。2只眼因新的视网膜裂孔需要再次手术。排除因眼部病变导致玻璃体出血的眼，平均视力从手动提高到6/12（p < 0.001）。
对于自发性致密眼底模糊的玻璃体出血和玻璃体后脱离，早期玻璃体切除术是安全的。由于本研究中的患者数量较少，需要进行一项前瞻性随机对照研究，比较早期与晚期玻璃体切除术，以确定早期手术是否也能预防增殖性玻璃体视网膜病变的形成。
