Hsiao Shu-Fang, Shih Min-Hsiu, Huang Fu-Chin
Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
Taiwan J Ophthalmol. 2016 Jan-Mar;6(1):36-41. doi: 10.1016/j.tjo.2014.10.008. Epub 2015 Jan 20.
We present the clinical course, management, and final outcome of spontaneous suprachoroidal hemorrhage (SSCH) in an age-related macular degeneration (AMD) patient-a 64-year-old male receiving antiplatelet therapy who developed SSCH during the Valsalva maneuver. In addition to our case study, we discuss the results of a systemic review of the literature and reference lists of retrieved studies published from January 2001 to December 2013. Among a total of 31 patients (32 eyes), acute secondary glaucoma was a complication in 87.5% of the cases, and over half of the cases (20 eyes, 62.5%) received surgery. Twenty cases (64.5%) were characterized by systemic hypertension (HTN), followed by cardiovascular or cerebral vascular disease in 17 cases (54.8%). The Valsalva maneuver was performed in five cases (16.1%) prior to the episode. Twenty-three cases (74.2%) had abnormal hemostasis, including use of anticoagulants or thrombolytic agents (18 cases), chronic renal failure (CRF, 5 cases), and blood dyscrasia (3 cases). AMD was the most common (17 eyes of 16 patients, 53.1%) ocular disease. Visual acuity was classified as hand motion (HM) or worse in 20 eyes (of 28 eyes, 71.4%) at initial presentation and in 24 eyes (of 30 eyes, 80%) upon final examination. Anticoagulated patients with AMD should be informed of the risk of intraocular hemorrhage. Medical therapy usually fails in the treatment of glaucoma. Surgical intervention provides an option for the purpose of pain relief. Even so, the final visual prognosis is usually poor.
我们报告了一名年龄相关性黄斑变性（AMD）患者发生自发性脉络膜上腔出血（SSCH）的临床过程、治疗及最终结局。该患者为一名64岁男性，正在接受抗血小板治疗，在Valsalva动作期间发生了SSCH。除了我们的病例研究外，我们还讨论了对2001年1月至2013年12月发表的文献及检索到的研究的参考文献列表进行系统评价的结果。在总共31例患者（32只眼）中，87.5%的病例出现急性继发性青光眼并发症，超过半数病例（20只眼，62.5%）接受了手术。20例（64.5%）患者有系统性高血压（HTN），其次是17例（54.8%）患有心血管或脑血管疾病。5例（16.1%）患者在发病前进行了Valsalva动作。23例（74.2%）患者存在止血异常，包括使用抗凝剂或溶栓剂（18例）、慢性肾衰竭（CRF，5例）和血液系统疾病（3例）。AMD是最常见的眼部疾病（16例患者中的17只眼，53.1%）。初诊时28只眼中有20只眼（71.4%）视力被分类为手动（HM）或更差，最终检查时30只眼中有24只眼（80%）视力如此。患有AMD的抗凝患者应被告知眼内出血的风险。药物治疗通常对青光眼治疗无效。手术干预为缓解疼痛提供了一种选择。即便如此，最终的视力预后通常较差。
