前言:目的评价一种新的引流术治疗息肉状脉络膜血管病变(PCV)出血性视网膜脱离(RD)患者视网膜下出血(SRH)的疗效。方法43只眼因PCV引起的出血性RD行玻璃体切除术。行巩膜切开外引流25只眼,行视网膜切开内引流18只眼,分别。根据不同的手术技术,外引流组分为单纯外引流亚组(10只眼),外引流联合玻璃体腔注射重组组织型纤溶酶原激活剂(tPA)亚组(7只眼),外引流联合视网膜下和/或黄斑下注射tPA亚组(8只眼);内引流组分为小视网膜切开术亚组(7只眼)和大视网膜切开术亚组(11只眼)。比较不同组和亚组间视网膜解剖复位情况及术后并发症。结果外引流技术平均手术时间短,与内引流术相比,视网膜复位率更高,术后并发症发生率更低。与小视网膜切开术亚组和无tPA外引流组相比,大视网膜切开术亚组和外引流联合视网膜下和/或黄斑下注射tPA亚组的中央凹下出血消退明显较快(p<0.05)。与其他亚组相比,小视网膜切开术亚组术后第一周出血和IOP升高的发生率更高(p<0.05)。讨论/结论我们的结果表明,外引流SRH联合视网膜下和/或黄斑下注射tPA可以使操作更简单。缩短手术时间,减少术后并发症,快速消退中央凹下出血,导致治疗出血性RD的有效和安全的治疗策略。
BACKGROUND: The aim of this study was to evaluate the therapeutic effect of a new drainage procedure for treating subretinal hemorrhage (SRH) in hemorrhagic retinal detachment (RD) in patients with polypoidal choroidal vasculopathy (PCV).
METHODS: Forty-three eyes with hemorrhagic RD attributable to PCV underwent vitrectomy. External drainage via sclerotomy was performed in 25 eyes and internal drainage via
retinotomy was performed in 18 eyes, respectively. Based on different surgical techniques, the external drainage group was divided into simple external drainage subgroup (10 eyes), external drainage combined with intravitreal injections of recombinant tissue plasminogen activator (tPA) subgroup (7 eyes), and external drainage combined with subretinal and/or submacular injections of tPA subgroup (8 eyes). The internal drainage group was divided into small
retinotomy subgroup (7 eyes) and large
retinotomy subgroup (11 eyes). The anatomic reattachment of the retina and postoperative complications were compared between different groups and subgroups.
RESULTS: The external drainage technique had shorter mean operation time, higher retinal reattachment rate, and fewer postoperative complications rate compared to the internal drainage procedure. The subfoveal hemorrhage subsided significantly sooner in the large
retinotomy subgroup and external drainage combined with subretinal and/or submacular injections of tPA subgroup compared to the small
retinotomy subgroup and the external drainage without tPA group (p < 0.05). The small
retinotomy subgroup had higher rates of hemorrhage and elevated IOP compared to other subgroups during the first week of the postoperative period (p < 0.05).
CONCLUSIONS: Our results suggest that external drainage of SRH combined with subretinal and/or submacular injections of tPA can make the operation simpler, shorten the operation time, reduce the postoperative complications with rapid regression of subfoveal hemorrhage, resulting in an effective and safe therapeutic strategy for treating hemorrhagic RD.