【摘要】目的：探讨玻璃体切除联合内界膜剥除术对Valsalva视网膜病变的疗效与安全性。方法：对因Valsalva视网膜病变接受玻璃体手术治疗的6例7眼的临床资料进行回顾分析。所有患眼均有不同程度的黄斑内界膜下积血，3眼伴少量玻璃体积血，均以玻璃体切除联合内界膜剥除术治疗。结果：患眼视力由术前的指数或手动提高至术后第1d的0.1～0.5,并在术后1mo内继续提高，术后3，6mo；1a随诊时仍维持稳定。随访期内未观察到严重并发症。结论：玻璃体切除联合内界膜剥除术是安全、有效的治疗严重Valsalva视网膜病变的方法。
【关键词】 视网膜出血；外科学；玻璃体切除术；治疗效果；Valsalva动作
Vitrectomy with internal limiting membrane peeling for Valsalva retinopathy
ShaoBo Lei, LuoSheng Tang, XiaoHua Zhu, XiaoJian Guo
Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Abstract
AIM: To evaluate the efficacy and safety of vitrectomy with internal limiting membrane (ILM) peeling as a treatment for Valsalva retinopathy.
METHODS: Six cases (7 eyes) with Valsalva retinopathy were treated by vitrectomy surgery and their clinical documents were retrospectively analyzed. All eyes presented premacular subILM hemorrhage, in which 3 eyes were with minor vitreous hemorrhage. Treatment was standard vitrectomy with ILMpeeling.
RESULTS: Vision was improved from fingercounting or handmotion preoperatively to 0.10.5 in all eyes at the first day after operation, increased gradually within 1 month and maintained stable at 3, 6 months and 1 year during the following up. There were no serious complications.
CONCLUSION: Vitrectomy with ILMpeeling is a safe and effective alternative to conservative treatment or YAG laser membranotomy for treating selected cases of Valsalva retinopathy.
KEYWORDS: retinal hemorrhage surgery; vitrectomy; treatment efficacy; Valsalva maneuver
0引言
Valsalva视网膜病变是由于在用力做提拉、推举重物、呕吐、咳嗽、哭泣、吹气等动作时，声门关闭，胸腹腔内压力急剧升高（Valsalva动作），以致视网膜毛细血管破裂而导致的出血性视网膜病变[1]。出血量大时常出现黄斑区内界膜下的积血和玻璃体积血，严重影响视力。本院对一组Valsalva视网膜病变病例进行了玻璃体手术治疗，现将临床资料回顾分析如下。
1对象和方法
1.1对象 2003/2007，中南大学湘雅二医院眼科收治的Valsalva视网膜病变6例7眼。平均年龄33(21～46)岁，男4例，女2例。3例为右眼、2例为左眼、1例为双眼发病。病程由2d～2mo不等。表现为举重、俯卧撑、哭喊、用力吹气或用力解大便等动作后眼前黑影遮挡，视力骤降。所有病例除屈光不正外无特殊眼病史或系统性疾病史，2眼曾行YAG激光内界膜切开引流，但未成功。患眼视力均为指数或手动，色觉以及光定位均正常。患眼眼底见黄斑前圆形或椭圆形圆顶状隆起的内界膜下积血灶，直径由3～6PD不等，上界可见液平面。3眼伴少量玻璃体积血（2眼为YAG激光击破内界膜所致），4眼伴后极部散在斑片状视网膜内出血。眼底荧光素血管造影检查除出血遮蔽外无异常荧光，单眼发病者对侧眼均无明显异常。所有病例的血压、血细胞计数、凝血功能以及肝肾功能均无异常。
1.2方法 手术为标准20G三通道闭合式后部玻璃体切除术，术中造玻璃体后脱离后确认积血位于内界膜下，行内界膜切开并剥除，积血以笛针吸出。术后随访观察最佳矫正视力、眼压及并发症，随访时间3mo～1a，平均6mo。
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