非外伤性玻璃体积血的病因及预后分析.doc

非外伤性玻璃体积血的病因及预后分析 [摘要] 目的：探讨非外伤性玻璃体积血的病因及与视力预后的关系。方法：分析2007年6月至2009年3月56例60眼资料完整且行玻璃体切割术治疗的非外伤性玻璃体积血病例，观察术前术后病因诊断的类别及变化、不同病因术后视力的转归、黄斑区及视神经有无病变对术后视力的影响等情况。结果：56例患者中糖尿病性视网膜病变（以下简称DR）22例24眼，视网膜裂孔无RD 4例4眼，孔源性视网膜脱离（RD）6例6眼，视网膜分支静脉阻塞（BRVO）14例14眼，视网膜血管炎4例6眼，BRVO合并RD的4例4眼，年龄相关性黄斑变性（AMD）2例2眼。视网膜裂孔无RD的患者，术后视力均达到0.3以上，其次为BRVO患者，视力0.3以上的8眼，BRVO合并RD的0.3以上2眼，DR视力0.3以上4眼，血管炎为2眼，RD和AMD的患者全部患眼视力均低于0.3。采用Wilcoxon秩和检验，有黄斑区及视神经病变组和无病变组术后视力比较差异有统计学意义。结论：本组非外伤性玻璃体积血的患者的病因排序为DR、BRVO、RD、视网膜裂孔不伴RD、视网膜血管炎、BRVO合并RD、AMD，因本组资料均为玻璃体出血量较大而行玻璃体切割手术治疗的病例，所以病因分布与以往的文献报导排列前5位的病因相似，但又有一定的特殊性，如发现了4例4眼视网膜分支静脉阻塞合并视网膜脱离的患者。其中视力预后较好的病因有视网膜裂孔，其次是BRVO，以下依次为BRVO合并RD，糖网和视网膜血管炎，RD和AMD。视力预后与各种病因是否导致黄斑区病变及视神经病变有密切相关，适时的玻璃体手术治疗有利于视力的恢复。 [关键词] 玻璃体积血；病因；预后 Analysis of etiological factor and prognosis on vitreous of non-traumatic origin. LI Jian-quan JIANG Shi-huai WANG Xiao-li QIAO Gang (Mianyang Central Hospital, Sichuan Mianyang 621000, China) [Abstactor] Objective: Analysis of etiological factor and prognosis on vitreous hemorrhage of non-traumatic origin, and to study their relationship. Methods: 56 patients (60 eyes) were studyed, whom were operated by vitrectomy, by contrasting visual activity, macular area and optical nerve pathological changes, etiological diagnosis. Result: In all patiens,22 patients (24eyes) were determined diabetic retinopathy after vitrectomy, 4 patients (4eyes) were tears retinal, 6 patients (6eyes) were detachment of retina, 14 patients (14eyes) were branch retinal vein occlusion, 4 patients (4eyes) were RD combine BRVO, 4 patients (6eyes) were retinal vasculitis, 2 patients (2eyes) were AMD. Patients with tears retinal or BRVO can got visual activity more than 0.3 but those who RD or AMD can get poor visual activity less than 0.3 after operation. There were statistical significance between patients with macular area or optical nerve pathological changes and those who without these pathological changes by Wilcoxon rank sum test. Conclution: The etiological factors of vitreous hemo