Wirostko W J, Han D P, Mieler W F, Pulido J S, Connor T B, Kuhn E
The Eye Institute, Medical College of Wisconsin, Milwaukee 53226, USA.
Ophthalmology. 1998 Dec;105(12):2271-5. doi: 10.1016/S0161-6420(98)91228-3.
To report the visual and anatomic outcome after surgical drainage of suprachoroidal hemorrhage according to hemorrhage severity.
A retrospective chart review.
Forty-eight consecutive eyes undergoing surgical drainage of a suprachoroidal hemorrhage at The Medical College of Wisconsin were examined.
Demographic and clinical data were abstracted from patients' medical records. Eyes were classified into four categories of increasing hemorrhage complexity: (1) nonappositional choroidal hemorrhage without vitreous or retinal incarceration in the wound (12 eyes); (2) centrally appositional choroidal hemorrhage without vitreous or retinal incarceration in the wound (17 eyes); (3) choroidal hemorrhage with associated vitreous incarceration in the wound (11 eyes); and (4) choroidal hemorrhage with associated retinal incarceration in the wound (8 eyes).
Visual acuity, rate of persistent hypotony, and incidence of irreparable retinal detachment after surgical drainage for four classes of suprachoroidal hemorrhage were defined.
Overall, 11 (23%) of 48 eyes had no light perception (NLP) vision develop, 9 (19%) of 48 eyes had persistent postsurgical hypotony (intraocular pressure < 6), and 21 (64%) of 33 eyes with retinal detachment enjoyed successful retinal reattachment surgery. A definite trend toward an increased rate of NLP vision (P < 0.02), persistent hypotony (P < 0.05), and irreparable retinal detachment (P = 0.11) was observed with increasing suprachoroidal hemorrhage complexity. Eyes with retinal incarceration, compared to eyes without retinal incarceration, had an increased rate of NLP vision (63% vs. 15%; P < 0.01), persistent postsurgical hypotony (50% vs. 13%; P < 0.05), and irreparable retinal detachment (50% vs. 20%; P = 0.07).
Eyes requiring surgical drainage of a suprachoroidal hemorrhage have a guarded prognosis, with a poorer outcome associated with increasing hemorrhage complexity. A classification system incorporating choroidal apposition, and vitreous and retinal incarceration in the wound, provides a format for reporting and assessing the efficacy of management strategies in this condition.
根据脉络膜上腔出血的严重程度报告手术引流后的视力和解剖学结果。
回顾性病历审查。
对威斯康星医学院连续48只接受脉络膜上腔出血手术引流的眼睛进行检查。
从患者病历中提取人口统计学和临床数据。眼睛被分为四类，出血复杂性逐渐增加：（1）非贴附性脉络膜出血，伤口无玻璃体或视网膜嵌顿（12只眼）；（2）中央贴附性脉络膜出血，伤口无玻璃体或视网膜嵌顿（17只眼）；（3）脉络膜出血伴伤口玻璃体嵌顿（11只眼）；（4）脉络膜出血伴伤口视网膜嵌顿（8只眼）。
定义了四类脉络膜上腔出血手术引流后的视力、持续性低眼压发生率和不可修复性视网膜脱离发生率。
总体而言，48只眼中有11只（23%）出现无光感（NLP）视力，48只眼中有9只（19%）术后持续性低眼压（眼压<6）(，33只视网膜脱离眼中有21只（64%）视网膜复位手术成功。随着脉络膜上腔出血复杂性增加，观察到NLP视力发生率增加（P<0.02）、持续性低眼压发生率增加（P<0.05）和不可修复性视网膜脱离发生率增加（P=0.11）的明确趋势。与无视网膜嵌顿的眼睛相比，有视网膜嵌顿的眼睛NLP视力发生率增加（63%对15%；P<0.01）、术后持续性低眼压发生率增加（50%对13%；P<0.05）和不可修复性视网膜脱离发生率增加（50%对20%；P=0.07）。
需要进行脉络膜上腔出血手术引流的眼睛预后不佳，出血复杂性增加与预后较差相关。一个纳入脉络膜贴附、玻璃体和视网膜在伤口嵌顿情况的分类系统，为报告和评估这种情况下的治疗策略疗效提供了一种形式。
