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目的分析自发性黄斑区出血性视网膜脱离的临床特征,提高对本病的诊治水平。方法对1998年9月至2003年3月我院眼底病科临床确诊的黄斑区视网膜下出血,范围大于4DD×5DD的患者,共23例(23只眼)的连续临床资料进行回顾性分析。经荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及B型超声波检查,进行病因分析,随诊观察视力及眼底变化。结果23例患者均表现为视力突然减退至0.2以下或光感。23只眼中7只眼确诊为老年性黄斑变性的脉络膜新生血管(CNV);5只眼为息肉状脉络膜血管病变(PCV);2只眼为视网膜大动脉瘤;9只眼病因不明。23只眼中3只眼积血吸收,黄斑中心凹无瘢痕形成,视力恢复0.4~0.8;12只眼黄斑出血区形成机化瘢和色素增生,视力数指/眼前~0.2;另外8只眼并发玻璃体积血,其中3只眼行玻璃体切割术,黄斑区大片机化及瘢痕,视力数指/66cm~0.2;5例视力丧失。结论自发性出血性视网膜脱离多发生于老年人,视力突然下降或丧失。出血形态表现为局灶性或弥漫性,因黄斑区组织严重损害,大部分病例预后差。
Objective To analyze the clinical features of spontaneous macular hemorrhagic retinal detachment and to improve the diagnosis and treatment of this disease. Methods The clinical data of 23 patients (23 eyes) with continuous diagnosis of retinal subarachnoid macular area and more than 4DD × 5DD clinically diagnosed in our department from September 1998 to March 2003 were analyzed retrospectively. Fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA) and B ultrasound examination, etiological analysis, follow-up visual acuity and fundus changes. Results All 23 patients presented with a sudden loss of vision below 0.2 or light perception. Seven of 23 eyes were diagnosed as choroidal neovascularization (CNV) with age-related macular degeneration. Five eyes had polypoidal choroidal vasculopathy (PCV), two had retinal aneurysms, and nine had unknown etiology. In 23 eyes, hemorrhage occured in 3 eyes, scar formed in foveal, and visual acuity recovered from 0.4 to 0.8. Twelve eyes of macular hemorrhage developed keloid and hyperpigmentation, while visual acuity was in the range of ~ 0.2 before the other 8 eyes Vitreous hemorrhage, of which 3 eyes underwent vitrectomy, macular area machine and scar large, visual acuity refers to /66cm ~ 0.2; 5 cases of loss of vision. Conclusion Spontaneous hemorrhagic retinal detachment occurred in the elderly, sudden loss of vision or loss. Hemorrhagic manifestations showed focal or diffuse, macular degeneration due to tissue damage, most cases of poor prognosis.