Ulbig M W, Mangouritsas G, Rothbacher H H, Hamilton A M, McHugh J D
University Eye Hospital, Ludwig Maximilians University, Munich, Germany.
Arch Ophthalmol. 1998 Nov;116(11):1465-9. doi: 10.1001/archopht.116.11.1465.
To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser in a large series of patients with long-term follow-up.
A retrospective review was conducted on 21 eyes with a circumscribed premacular subhyaloid hemorrhage of various causes. These eyes were treated with a pulsed Nd:YAG laser to drain the entrapped blood into the vitreous. The period of review ranged from 12 to 32 months (mean, 22 months).
In 16 eyes, visual acuity improved within 1 month. Four eyes had persistent, dense, nonclearing vitreous opacity for at least 3 months and finally required vitrectomy. One clotted hemorrhage did not drain into the vitreous. Final visual outcome was determined by the underlying diagnosis, such as Valsalva retinopathy (7 eyes), diabetic retinopathy (7 eyes), branch retinal vein occlusion (4 eyes), and retinal macroaneurysm, Terson syndrome, or blood dyscrasia (1 eye each). Eyes with Valsalva retinopathy fared the best. Complications included a macular hole in 1 eye and a retinal detachment from a retinal break in a myopic patient.
Drainage of premacular subhyaloid hemorrhage into the vitreous with an Nd:YAG laser is a viable treatment alternative for eyes with recent bleeding. However, a macular hole and a retinal detachment were observed as complications. Thus, to establish Nd:YAG laser treatment as a routine procedure, the risks and benefits have to be weighed in a randomized trial and compared with those of deferral of treatment or primary vitrectomy.
在大量患者中进行长期随访，研究用钕钇铝石榴石（Nd:YAG）激光将黄斑前玻璃体下出血引流至玻璃体的效果。
对21只因各种原因导致的局限性黄斑前玻璃体下出血的眼睛进行回顾性研究。用脉冲Nd:YAG激光治疗这些眼睛，将积血引流至玻璃体。随访时间为12至32个月（平均22个月）。
16只眼睛的视力在1个月内有所改善。4只眼睛出现持续、浓密、不消退的玻璃体混浊至少3个月，最终需要进行玻璃体切除术。一处凝血性出血未引流至玻璃体。最终视力结果取决于潜在诊断，如瓦尔萨尔瓦视网膜病变（7只眼）、糖尿病性视网膜病变（7只眼）、视网膜分支静脉阻塞（4只眼）以及视网膜大动脉瘤、泰森综合征或血液系统疾病（各1只眼）。瓦尔萨尔瓦视网膜病变的眼睛预后最佳。并发症包括1只眼出现黄斑裂孔，1例近视患者因视网膜裂孔导致视网膜脱离。
用Nd:YAG激光将黄斑前玻璃体下出血引流至玻璃体是近期出血眼睛的一种可行治疗选择。然而，观察到黄斑裂孔和视网膜脱离为并发症。因此，要将Nd:YAG激光治疗确立为常规治疗方法，必须在随机试验中权衡风险和益处，并与延迟治疗或一期玻璃体切除术的风险和益处进行比较。
