Ament Christine Shortsleeve, Zacks David N, Lane Anne Marie, Krzystolik Magdalena, D'Amico Donald J, Mukai Shizuo, Young Lucy H, Loewenstein John, Arroyo Jorge, Miller Joan W
Retina Service and Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
Arch Ophthalmol. 2006 Jul;124(7):957-66. doi: 10.1001/archopht.124.7.957.
To determine predictors of choroidal neovascularization (CNV) and visual outcome after traumatic choroidal rupture.
A retrospective review of patients with traumatic choroidal rupture diagnosed in the Retina Service, Massachusetts Eye and Ear Infirmary, Boston, between January 1993 and August 2001 was performed. Parametric and nonparametric statistical methods were used to evaluate visual prognosis, CNV, and retinal detachment after traumatic choroidal rupture.
One hundred eleven cases were identified and reviewed. Visual acuity (VA) changes were recorded in all of the cases. Thirty-eight (34%) of the 111 patients recovered driving vision (VA > or =20/40). Rupture location was recorded in 107 cases. Recovery of driving vision was seen in 20 (59%) of 34 eyes with peripheral choroidal ruptures, 17 (22%) of 73 eyes with macular choroidal ruptures, 38 (38%) of 99 eyes without CNV, 1 (8%) of 12 eyes with CNV, 38 (40%) of 96 eyes without retinal detachment, and 1 (7%) of 15 eyes with retinal detachment. Older age and location of rupture within the arcades were positively associated with CNV formation (P = .04 and .03, respectively). Foveal location of rupture, multiple ruptures, and poor baseline VA were associated with failure to recover driving vision in univariate regression analyses. In multivariate analysis, rupture location and baseline VA were independently associated with visual outcome. Of 12 patients diagnosed with CNV, 5 were not treated, 4 were treated with argon laser photocoagulation, 1 was treated with surgery, 1 was treated with argon laser photocoagulation followed by surgery, and 1 was treated with verteporfin photodynamic therapy.
Most patients with traumatic choroidal rupture do not achieve final VA of 20/40 or better. Poor visual outcome was most highly associated with a macular rupture and baseline VA of less than 20/40. The formation of CNV was most strongly associated with older age and macular choroidal rupture.
确定外伤性脉络膜破裂后脉络膜新生血管（CNV）的预测因素及视力预后。
对1993年1月至2001年8月在波士顿马萨诸塞州眼耳医院视网膜科诊断为外伤性脉络膜破裂的患者进行回顾性研究。采用参数和非参数统计方法评估外伤性脉络膜破裂后的视力预后、CNV及视网膜脱离情况。
共确定并回顾了111例病例。记录了所有病例的视力（VA）变化。111例患者中有38例（34%）恢复到可驾车视力（VA≥20/40）。记录了107例的破裂位置。周边脉络膜破裂的34只眼中有20只（59%）恢复到可驾车视力，黄斑脉络膜破裂的73只眼中有17只（22%）恢复到可驾车视力，无CNV的99只眼中有38只（38%）恢复到可驾车视力，有CNV的12只眼中有1只（8%）恢复到可驾车视力，无视网膜脱离的96只眼中有38只（40%）恢复到可驾车视力，有视网膜脱离的15只眼中有1只（7%）恢复到可驾车视力。年龄较大及破裂位于拱环内与CNV形成呈正相关（P分别为0.04和0.03）。在单因素回归分析中，破裂位于黄斑区、多处破裂及基线视力差与未能恢复到可驾车视力相关。在多因素分析中，破裂位置和基线视力与视力预后独立相关。在12例诊断为CNV的患者中，5例未治疗，4例接受氩激光光凝治疗，1例接受手术治疗，1例先接受氩激光光凝治疗后再行手术治疗，1例接受维替泊芬光动力治疗。
大多数外伤性脉络膜破裂患者最终视力未达到20/40或更好。视力预后差与黄斑破裂及基线视力低于20/40高度相关。CNV的形成与年龄较大及黄斑脉络膜破裂密切相关。
