摘要
目的:息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)是全球中老年人视力丧失的主要原因,在亚洲人中较为常见。当其由于动脉瘤样扩张的血管或管径增宽的小静脉/小动脉破裂时,将导致黄斑区视网膜下出血(submacular hemorrhage,SMH),并随着时间的延长造成视力不可逆的损伤。本研究探讨经平坦部玻璃体切除(pars-plana vitrectomy,PPV)联合术中视网膜下注射组织型纤溶酶原激活剂(tissue-type plasminogen activator,t-PA)及术后玻璃体腔注射抗血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)治疗对PCV并发SMH的手术效果及并发症。方法:选取2020年9月至2021年12月中南大学湘雅医院眼科中心收治的PCV合并SMH的13例(13只眼)患者。纳入的患者术中均接受PPV联合视网膜下注射t-PA,术后进行玻璃体腔抗VEGF注射治疗,分析患者术前、术后1周、术后1个月及术后6个月时的最佳矫正视力(best corrected visual acuity,BCVA)、眼压、视网膜下出血吸收、原发病灶进展,手术并发症及术后疗效相关因素。结果:13例患者均完成术后6个月的随访,随访截止时全部患者的视网膜下积血均完全清除;术后1个月及术后6个月的BCVA较术前及术后1周均明显提升(均P<0.05);年龄大于60岁及小于60岁,病灶位于中心凹下及中心凹外的患者最终视力恢复差异有统计学意义(分别为P=0.045和P=0.006);病程、出血范围、术前合并或不合并玻璃体积血(vitreoushemorrhage,VH)与术后6个月视力的恢复无明显相关性(均P>0.05);10例椭圆体带完整,5例视网膜色素上皮层完整,微结构完整与不完整之间术前、术后视力差异无统计学意义(均P>0.05)。最终复查时存在视网膜神经上皮层水肿的有2例,视网膜色素上皮层脱离的1例。术后并发症包括1例黄斑裂孔,1例视网膜色素上皮层撕裂,结论:PPV联合视网膜下t-PA注射,术后玻璃体腔抗VEGF注射能有效清除继发于PCV的SMH,手术并发症较少,在6个月的随访中,患者的视功能可得到显著提高。
Objective:Polypoidal choroidal vasculopathy(PCV)is a major cause of vision loss among older adults worldwide and is particularly common in Asians.When the aneurysmal dilatation of blood vessels or the rupture of widened small veins/arteries occurs,it leads to submacular hemorrhage(SMH),which can result in irreversible damage to vision over time.This study aims to evaluate the surgical outcomes and complications of pars plana vitrectomy(PPV)combined with intraoperative subretinal injection of tissue-type plasminogen activator(t-PA)and postoperative intravitreal injection of anti-vascular endothelial growth factor(VEGF)for the treatment of SMH secondary to PCV.Methods:Thirteen patients(13 eyes)with SMH secondary to PCV treated at the Eye Center,Xiangya Hospital,Central South University,from September 2020 to December 2021,were included in this study.All patients underwent PPV combined with subretinal injection of t-PA during surgery and received postoperative intravitreal injections of anti-VEGF.Best corrected visual acuity(BCVA),intraocular pressure,absorption of subretinal hemorrhage,progression of the primary lesion,surgical complications,and factors associated with postoperative efficacy were analyzed preoperatively,1 week postoperatively,1 month postoperatively,and 6 months postoperatively.Results:All patients completed the 6-month follow-up,and at the final visit,100%of the subretinal hemorrhage of 13 patients was completely cleared.BCVA significantly improved at both 1 month and 6 months postoperatively compared to preoperative and 1-week postoperative levels(all P<0.05).Patients over 60 years old and those with lesions located beneath the fovea had statistically significant differences in visual recovery compared to younger patients and those with extrafoveal lesions(P=0.045 and P=0.006,respectively).No significant correlation was found between disease duration,extent of hemorrhage,presence or absence of preoperative vitreous hemorrhage(VH),and visual recovery at 6 months postoperatively(all P>0.05).Ten patients had an intact ellipsoid zone,and 5 patients had an intact retinal pigment epithelium layer,however,the difference in preoperative and postoperative visual acuity between those with and without intact microstructures was not statistically significant(all P>0.05).At the final follow-up,2 patients had retinal neuroepithelial edema,and 1 patient had retinal pigment epithelium layer detachment.Postoperative complications included 1 patient of macular hole and 1 patient of retinal pigment epithelium layer tear.Conclusion:PPV combined with subretinal t-PA injection and postoperative intravitreal anti-VEGF injection effectively clears SMH secondary to PVC with few surgical complications and significantly improves visual function of the patients over 6-month long-term follow-up.
作者
郑国丽
王楠
雷文博
徐瑶
夏晓波
熊思齐
ZHENG Guoli;WANG Nan;LEI Wenbo;XU Yao;XIA Xiaobo;XIONG Siqi(Eye Center,Xiangya Hospital,Central South University,Changsha 410008;Hunan Key Laboratory of Ophthalmology,Changsha 410008,China)
出处
《中南大学学报(医学版)》
CSCD
北大核心
2024年第9期1431-1439,共9页
Journal of Central South University :Medical Science
基金
国家重点研发计划(2020YFC2008205)。
