Piper J G, Han D P, Abrams G W, Mieler W F
Department of Ophthalmology, Medical College of Wisconsin, Milwaukee 53226.
Ophthalmology. 1993 May;100(5):699-704. doi: 10.1016/s0161-6420(93)31586-1.
Risk factors for choroidal hemorrhage during pars plana vitrectomy surgery are currently not well defined. The authors analyzed potential risk factors for perioperative choroidal hemorrhage at pars plana vitrectomy in a case-control study.
Of 683 consecutive vitrectomy procedures, 13 cases of choroidal hemorrhage were identified in the operative or immediate postoperative period. Fifty vitrectomy controls from the same period were randomly selected and were compared with the hemorrhage cases by univariate analysis with respect to various potential risk factors.
The incidence of choroidal hemorrhage associated with vitrectomy was 1.9%. Statistically significant risks (P < or = 0.05) included: greater age (mean, 70.9 versus 52.1 years); elevated preoperative pressure (19.9 versus 13.0 mmHg); preoperative diagnosis of rhegmatogenous retinal detachment (relative risk, 8.1); aphakic or pseudophakic status (relative risk, 5.2); and scleral buckle procedure at vitrectomy (relative risk, 12.0). Eyes with previous ocular trauma and previous vitrectomy had a reduced risk of choroidal hemorrhage. The incidence of severe visual loss (final visual acuity < 5/200) did not differ significantly from controls.
Significant risk factors for choroidal hemorrhage are identified in this study which may help to identify patients at increased risk for this complication. Good visual outcome is possible after choroidal hemorrhage at vitrectomy (69% with visual acuity > 5/200).
目前，玻璃体切除术中脉络膜出血的危险因素尚未明确界定。作者在一项病例对照研究中分析了玻璃体切除术中围手术期脉络膜出血的潜在危险因素。
在连续683例玻璃体切除手术中，有13例在手术中或术后即刻发生脉络膜出血。随机选取同期50例玻璃体切除对照病例，并就各种潜在危险因素通过单因素分析与出血病例进行比较。
与玻璃体切除术相关的脉络膜出血发生率为1.9%。具有统计学意义的危险因素（P≤0.05）包括：年龄较大（平均70.9岁对52.1岁）；术前眼压升高（19.9mmHg对13.0mmHg）；术前诊断为孔源性视网膜脱离（相对危险度，8.1）；无晶状体或人工晶状体状态（相对危险度，5.2）；以及玻璃体切除术中行巩膜扣带术（相对危险度，12.0）。既往有眼外伤和既往有玻璃体切除术的眼发生脉络膜出血的风险降低。严重视力丧失（最终视力<5/200）的发生率与对照组无显著差异。
本研究确定了脉络膜出血的重要危险因素，这可能有助于识别发生该并发症风险增加的患者。玻璃体切除术中发生脉络膜出血后仍有可能获得良好的视力预后（69%的患者视力>5/200）。
