Department of Ophthalmology and Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Department of Ophthalmology and Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Toronto Retina Institute, Toronto, Ont.
Can J Ophthalmol. 2018 Aug;53(4):408-414. doi: 10.1016/j.jcjo.2017.10.010. Epub 2017 Dec 23.
To report the anatomical and visual outcomes of patients with thick submacular hemorrhage (SMH) treated with pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (t-PA), and pneumatic displacement.
Single-centre, retrospective case series.
A total of 99 eyes of 99 consecutive patients with thick SMH secondary to any underlying etiology treated with PPV with subretinal t-PA and pneumatic displacement by 6 vitreoretinal surgeons at St. Michael's Hospital, Toronto, between July 2004 and August 2016.
All medical records and colour fundus photographs were reviewed for data collection. Blood displacement was evaluated at follow-up visits and classified as complete, partial, or none. Main outcome measures included blood displacement at final follow-up, postoperative Snellen best-corrected visual acuities (BCVA), and complication and recurrence rates.
Patients had a mean age of 77.7 ± 12.3 years and were followed up for an average of 18.4 ± 22.3 months. Wet age-related macular degeneration was the most common etiology associated with thick SMH (80.8%). Complete blood displacement was observed by final follow-up in 85.9% of the cases, partial displacement in 12.1%, and none in 2.0%. Mean logMAR BCVA improved from 2.03 ± 0.81 (Snellen 20/2143) at baseline to 1.80 ± 1.00 (Snellen 20/1262; p = 0.009) at final follow-up, and baseline BCVA was a significant predictor of final BCVA (p < 0.001). Early postoperative complications included vitreous hemorrhage in 13 eyes and rhegmatogenous retinal detachment in 8. Recurrent SMH was observed in 12 cases.
Vitrectomy with subretinal t-PA and pneumatic displacement seems to be an effective treatment for SMH in terms of blood displacement and visual outcomes.
报告采用经睫状体平坦部玻璃体切除术（PPV）、视网膜下组织型纤溶酶原激活剂（t-PA）和气动移位治疗厚型黄斑下出血（SMH）患者的解剖和视力结果。
单中心回顾性病例系列研究。
2004 年 7 月至 2016 年 8 月，多伦多圣迈克尔医院的 6 名玻璃体视网膜外科医生对 99 例继发于任何潜在病因的厚型 SMH 患者的 99 只眼进行了 PPV 联合视网膜下 t-PA 和气动移位治疗。
所有病历和眼底彩照均用于数据收集。通过随访评估血液移位情况，并分为完全、部分或无。主要观察指标包括最终随访时的血液移位、术后最佳矫正视力（BCVA）、并发症和复发率。
患者的平均年龄为 77.7 ± 12.3 岁，平均随访 18.4 ± 22.3 个月。湿性年龄相关性黄斑变性是与厚型 SMH 最常见的病因（80.8%）。85.9%的病例最终随访时观察到完全血液移位，12.1%的病例观察到部分血液移位，2.0%的病例未观察到血液移位。平均 logMAR BCVA 从基线时的 2.03 ± 0.81（Snellen 20/2143）改善到最终随访时的 1.80 ± 1.00（Snellen 20/1262；p = 0.009），基线 BCVA 是最终 BCVA 的显著预测因素（p < 0.001）。早期术后并发症包括 13 只眼玻璃体积血和 8 只眼孔源性视网膜脱离。12 例患者出现复发性 SMH。
PPV 联合视网膜下 t-PA 和气动移位治疗 SMH 在血液移位和视力结果方面似乎是一种有效的治疗方法。
