苏格兰黄斑下出血（SMH）的发生率：苏格兰眼科监测单位（SOSU）研究。
Incidence of submacular haemorrhage (SMH) in Scotland: a Scottish Ophthalmic Surveillance Unit (SOSU) study.
机构信息
Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK.
Sunderland Eye Infirmary, Sunderland, Institute of Genetic Medicine, Newcastle University, Newcastle, UK.
出版信息
Eye (Lond). 2019 Mar;33(3):486-491. doi: 10.1038/s41433-018-0239-4. Epub 2018 Oct 29.
PURPOSE
Submacular haemorrhage (SMH) is a cause of severe visual loss in neovascular age-related macular degeneration (nAMD). The incidence is uncertain and furthermore there is no widely used classification system nor agreed best practice. The aim of this national surveillance study was to identify the incidence, presenting features and clinical course of new fovea-involving submacular haemorrhage associated with nAMD.
METHODS
A questionnaire was sent monthly to every ophthalmic specialist in Scotland over a 12-month period asking them to report all newly presenting patients with acute SMH secondary to nAMD of at least two disc diameters (DDs) in greatest linear diameter. A follow-up questionnaire was sent 6 months after initial presentation. Cases related to other causes were excluded.
RESULTS
Twenty-nine cases were reported giving an incidence of 5.4 per million per annum (range 2-15). The mean age was 83 years (range 66-96) and females accounted for 17/29 (59%). Fifteen of the 29 cases (52%) had a past history of AMD, of which 7 had nAMD. Nineteen of the 29 cases (66%) presented within 7 days of onset and the majority had SMH of < 11 DD (20/29, 69%). Treatment options comprised the following: observation (n = 6, 21%), anti-VEGF alone (n = 6, 21%) or vitrectomy with co-application of tissue plasminogen activator (TPA), anti-VEGF and gas (n = 17, 58%). The vitrectomy group experienced the greatest change in vision from logMAR 1.89-1.50 (p = 0.374). Four of 20 (20%) cases with 6 months follow-up suffered a re-bleed at a mean time of 96 days.
CONCLUSIONS
The incidence, clinical features and course of a consecutive national cohort of patients with SMH secondary to nAMD are presented.
目的
黄斑下出血（SMH）是新生血管性年龄相关性黄斑变性（nAMD）导致严重视力丧失的原因之一。其发病率尚不确定，也没有广泛使用的分类系统或公认的最佳治疗方法。本项全国性监测研究旨在确定与 nAMD 相关的新累及黄斑的 SMH 的发病情况、临床表现和病程。
方法
在 12 个月的时间里，每月向苏格兰的每位眼科专家发送一份问卷，要求他们报告所有新出现的至少有两个视盘直径（DD）的最大线性直径的 nAMD 继发急性 SMH 的患者。在初次就诊后 6 个月时发送了后续调查问卷。排除与其他原因相关的病例。
结果
报告了 29 例病例，发病率为每年每百万 5.4 例（范围为 2-15）。平均年龄为 83 岁（范围为 66-96 岁），女性占 29/29（59%）。29 例中的 15 例（52%）有 AMD 病史，其中 7 例为 nAMD。29 例中的 19 例（66%）在发病后 7 天内就诊，大多数 SMH < 11 DD（29/29，66%）。治疗方案包括以下几种：观察（n = 6，21%）、单独使用抗 VEGF（n = 6，21%）或玻璃体切割联合组织纤溶酶原激活剂（TPA）、抗 VEGF 和气体（n = 17，58%）。玻璃体切割组的视力变化最大，从 logMAR 1.89 变为 1.50（p = 0.374）。20 例中有 4 例（20%）在 6 个月的随访中再次出血，平均时间为 96 天。
结论
呈现了与 nAMD 相关的 SMH 连续国家队列患者的发病率、临床特征和病程。
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