Li Zhi-Xi, Hu Yi-Jun, Atik Alp, Lu Lin, Hu Jie
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China.
Aier School of Ophthalmology, Central South University, Changsha 410000, Hunan Province, China.
Int J Ophthalmol. 2019 Dec 18;12(12):1859-1864. doi: 10.18240/ijo.2019.12.07. eCollection 2019.
To describe the long-term observation of vitrectomy without subretinal hemorrhage (SRH) management for massive vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV).
This is a retrospective, consecutive case series. A total of 86 eyes of 86 patients with >14d of massive VH associated with PCV were included. All patients underwent vitrectomy without SRH management, followed by intravitreal ranibizumab injections and/or photodynamic therapy (PDT) as needed. The main outcome measures were best-corrected visual acuity (BCVA), postoperative adverse events and the recurrence of VH.
The average follow-up period was 25.5±9.2mo (range 12-35mo). Mean BCVA at baseline (2.16±0.39 logMAR) had improved significantly, both 3mo after surgery (1.42±0.66 logMAR, <0.001) and by the last visit (1.23±0.74 logMAR, <0.001). The common postoperative complications included macular subretinal fibrosis in 14 eyes (16.3%) and ciliary body detachment in 4 eyes (4.7%). Nineteen eyes (22.1%) received following treatment with ranibizumab injections without/with PDT, and 15 (17.4%) were resolved. Four eyes (4.7%) had recurrent hemorrhage during the follow-up period. In multiple regression analysis, thicker SRH (beta=0.33, =0.025) in the preoperative B-scan and the presence of foveal subretinal fibrosis (beta=0.28, =0.018) in the follow up were associated with poor postoperative BCVA.
Vitrectomy without SRH management for massive VH secondary to PCV improved/stabilized visual function in the long-term observation. Eyes presenting with thicker SRH preoperatively and forming foveal subretinal fibrosis in the follow-up period tended to have worse BCVA.
描述对息肉样脉络膜血管病变（PCV）继发的大量玻璃体积血（VH）行玻璃体切割术且不处理视网膜下出血（SRH）的长期观察结果。
这是一项回顾性连续病例系列研究。纳入86例患者的86只眼，这些患者均有与PCV相关的大量VH且病程超过14天。所有患者均接受了不处理SRH的玻璃体切割术，随后根据需要进行玻璃体内注射雷珠单抗和/或光动力疗法（PDT）。主要观察指标为最佳矫正视力（BCVA）、术后不良事件及VH复发情况。
平均随访时间为25.5±9.2个月（范围12 - 35个月）。基线时的平均BCVA（2.16±0.39 logMAR）在术后3个月（1.42±0.66 logMAR，P<0.001）和末次随访时（1.23±0.74 logMAR，P<0.001）均有显著改善。常见的术后并发症包括14只眼（16.3%）出现黄斑视网膜下纤维化，4只眼（4.7%）出现睫状体脱离。19只眼（22.1%）接受了雷珠单抗注射联合/不联合PDT的后续治疗，其中15只眼（17.4%）病情得到缓解。4只眼（4.7%）在随访期间出现了复发性出血。多元回归分析显示，术前B超中较厚的SRH（β = 0.33，P = 0.025）以及随访时存在黄斑视网膜下纤维化（β = 0.28，P = 0.018）与术后BCVA较差相关。
对PCV继发的大量VH行玻璃体切割术且不处理SRH在长期观察中可改善/稳定视功能。术前SRH较厚且随访期间形成黄斑视网膜下纤维化的眼，其BCVA往往较差。
