Chen Kuan-Jen, Sun Ming-Hui, Sun Chi-Chin, Wang Nan-Kai, Hou Chiun-Ho, Wu An-Lun, Wu Wei-Chi, Lai Chi-Chun
Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Ophthalmol Retina. 2019 Jan;3(1):53-60. doi: 10.1016/j.oret.2018.08.007. Epub 2018 Aug 25.
To investigate the visual outcomes of patients with traumatic maculopathy and massive subretinal hemorrhage (SRH) after closed-globe injury.
Retrospective, noncomparative, and interventional case series.
Twenty-four patients with traumatic maculopathy and massive SRH after closed-globe injury.
In this retrospective observational case series, we included 25 eyes of 24 patients who had experienced closed-globe injury with massive SRH.
The demographics, clinical characteristics, and final visual acuity (VA) of the patients.
Twenty-five eyes with massive SRHs involving the macula were studied with initial VAs from light perception to 4/200. At initial presentation, vitreous hemorrhages were present in 22 eyes, hyphema in 13 eyes, lid lacerations in 11 eyes, glaucoma in 8 eyes, iridodialysis in 7 eyes, afferent pupillary defect in 6 eyes, lens dislocation or subluxation in 5 eyes, and cyclodialysis clefts and hypotony in 2 eyes. Retinal detachment developed in 7 eyes during the follow-up period. Pars plana vitrectomy usually was performed in patients with persistent vitreous hemorrhage, retinal detachment, lens dislocation, and cyclodialysis cleft with hypotony. In final visual outcomes, 7 eyes achieved favorable visual outcomes with VA of 20/200 or more. Thirteen eyes showed VA of 2/200 or less with dense macular scars or foveal atrophy. Foveal atrophy showed encompassed foveal thinning, retinal pigment epithelial clumping, and the loss of external limiting membrane (ELM), ellipsoidal zone (EZ), and interdigital zone (IZ) on spectral-domain OCT. Fundus autofluorescence demonstrated interposed, reduced, and increased autofluorescence in traumatic pigment epitheliopathy.
Traumatic maculopathy and massive SRH after closed-globe injury often cause poor visual outcomes, especially in eyes with dense macular scars or foveal atrophy. Spectral-domain OCT findings in patients with good visual outcomes revealed partial to complete preservation of the foveal ELM, EZ, and IZ.
探讨闭合性眼球损伤后创伤性黄斑病变合并大量视网膜下出血（SRH）患者的视力预后。
回顾性、非对比性、干预性病例系列研究。
24例闭合性眼球损伤后创伤性黄斑病变合并大量SRH的患者。
在这个回顾性观察病例系列中，我们纳入了24例经历过闭合性眼球损伤合并大量SRH的患者的25只眼。
患者的人口统计学资料、临床特征及最终视力（VA）。
研究了25只黄斑区有大量SRH的眼睛，初始视力从光感至4/200。初诊时，22只眼有玻璃体积血，13只眼有前房积血，11只眼有眼睑裂伤，8只眼有青光眼，7只眼有虹膜根部离断，6只眼有传入性瞳孔障碍，5只眼有晶状体脱位或半脱位，2只眼有睫状体脱离和低眼压。随访期间7只眼发生视网膜脱离。对于持续性玻璃体积血、视网膜脱离、晶状体脱位及伴有低眼压的睫状体脱离患者，通常行玻璃体切除术。最终视力预后方面，7只眼视力良好，VA为20/200或更好。13只眼VA为2/200或更差，伴有致密的黄斑瘢痕或黄斑中心凹萎缩。黄斑中心凹萎缩表现为黄斑区变薄、视网膜色素上皮细胞团块形成，以及在频域光学相干断层扫描（OCT）上外核层界限膜（ELM）、椭圆体带（EZ）和指状突（IZ）的缺失。眼底自发荧光显示创伤性色素上皮病变中有插入性、减弱性和增强性自发荧光。
闭合性眼球损伤后创伤性黄斑病变合并大量SRH常导致视力预后不良，尤其是伴有致密黄斑瘢痕或黄斑中心凹萎缩的眼睛。视力预后良好患者的频域OCT表现显示黄斑区ELM、EZ和IZ部分或完全保留。
