Hochman M A, Seery C M, Zarbin M A
Department of Ophthalmology, University of Medicine and Dentistry, Newark, New Jersey, USA.
Surv Ophthalmol. 1997 Nov-Dec;42(3):195-213. doi: 10.1016/s0039-6257(97)00089-1.
Subretinal hemorrhage can arise from the retinal and/or choroidal circulation. Significant subretinal hemorrhage occurs in several conditions, but most commonly is associated with age-related macular degeneration, presumed ocular histoplasmosis, high myopia, retinal arterial macroaneurysm, and trauma. Released toxins, outer retinal shear forces, and a diffusion barrier created by subretinal hemorrhage all contribute to photoreceptor damage and visual loss. The use of tissue plasminogen activator and improvements in surgical instrumentation have facilitated surgical drainage and have made it a useful option in the management of selected cases. Mechanisms of subretinal hemorrhage formation, underlying etiologies, diagnostic evaluation, and the histopathology of damage are summarized. Published surgical series are reviewed and surgical advances are summarized. The value of surgically removing subretinal hemorrhages to improve visual outcome remains unestablished, because definitive studies have not been performed. Guidelines for selecting candidates for surgical intervention are proposed.
视网膜下出血可源于视网膜和/或脉络膜循环。严重的视网膜下出血见于多种情况，但最常见于年龄相关性黄斑变性、推测的眼组织胞浆菌病、高度近视、视网膜动脉大动脉瘤和外伤。释放的毒素、视网膜外层剪切力以及视网膜下出血形成的扩散屏障均会导致光感受器损伤和视力丧失。组织纤溶酶原激活剂的应用以及手术器械的改进促进了手术引流，并使其成为某些病例管理中的有用选择。本文总结了视网膜下出血形成的机制、潜在病因、诊断评估以及损伤的组织病理学。回顾了已发表的手术系列研究并总结了手术进展。由于尚未进行确定性研究，通过手术清除视网膜下出血以改善视力结果的价值尚未确立。本文提出了手术干预候选者的选择指南。
