Humayun M, Lewis H, Flynn H W, Sternberg P, Blumenkranz M S
Division of Ophthalmology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Am J Ophthalmol. 1998 Sep;126(3):358-61. doi: 10.1016/s0002-9394(98)00090-7.
Experience is reported with intraoperative pharmacologic lysis of recent submacular hemorrhage with tissue plasminogen activator followed by surgical drainage of the unclotted blood in patients with retinal arterial macroaneurysms.
Nine eyes (nine patients) with a recent (< or = 7 days old) submacular hemorrhage involving the center of the fovea secondary to retinal arterial macroaneurysm that were managed with recombinant tissue plasminogen activator-assisted subretinal hemorrhage evacuation, including subretinal injection of tissue plasminogen activator and removal of the liquefied blood. Patients were followed for a mean 18 +/- 7 months (range, 7 to 30 months).
All nine eyes had improved final corrected visual acuity after surgery, and eight eyes (89%) attained a corrected visual acuity of 20/60 or better (mean, 20/40; range, 20/20 to 20/200). Final corrected visual acuity was limited to 20/200 in one eye. Two eyes developed a cataract that required surgery.
Submacular surgery with tissue plasminogen activator-assisted thrombolysis achieved improved best-corrected visual acuity in eyes with recent submacular hemorrhage involving the center of the fovea associated with retinal arterial macroaneurysm.
报告对视网膜动脉大动脉瘤患者近期黄斑下出血进行术中组织纤溶酶原激活剂药物溶解，随后对未凝固血液进行手术引流的经验。
9只眼（9例患者）近期（≤7天）黄斑下出血累及黄斑中心凹，继发于视网膜动脉大动脉瘤，采用重组组织纤溶酶原激活剂辅助视网膜下出血清除术治疗，包括视网膜下注射组织纤溶酶原激活剂和清除液化血液。患者平均随访18±7个月（范围7至30个月）。
所有9只眼术后最终矫正视力均有改善，8只眼（89%）矫正视力达到20/60或更好（平均20/40；范围20/20至20/200）。1只眼最终矫正视力限于20/200。2只眼发生白内障需要手术治疗。
对于近期黄斑下出血累及黄斑中心凹且与视网膜动脉大动脉瘤相关的患者，采用组织纤溶酶原激活剂辅助溶栓的黄斑下手术可提高最佳矫正视力。
