|
Age-ralated macular degeneration,or,senile macular degeneration is the leading cause of permanent blindness in the old person.According to clinical and pathologic findings,the disease can be classified into two groups:non exudative(“dry”) and exudative(“wet”). Exudative age-related macular degeneration is the common reason for lower vision acuity, mainly due to subretinal hemorrhage and / or sub- pigment epithelium hemorrhage ,and even vitreous hemorrhage, which are caused by choroidal neovascularization.If the course of vitreous hemorrhage is long, it will be toxic to retina,and will have a series of complications.For the treatment of AMD vitreous hemorrhage,on the one hand,we will aviod of the complications caused by vitreous hemorrhage;on the other hand,we will avoid of the recurrence of CNV.If the vitreous hemorrhage does not absorb,vitrectomy should be held for excision of vitreous hemorrhage to avoid a series of complications, and surgery shoule be held as soon as possible. For the treatment of choroidal neovascularization, there are many methods at present,such as photodynamic therapy, laser photocoagulation therapy, transpupillary thermotherapy, macular translocation surgery, subretinal neovascular membrane stripping surgery, pigment epithelial cells transplantation. However, the postoperative complications are common,and the choroidal neovascularization is easier to relapse, and the visual acuity is not markedly improved.The clinical datum of thirty-two eyes of 32 patients’were studied retrospectively from Jan,2004 to Oct,2008,including the patients of vitreous hemorrhage caused by age-related macular degeneration. The relationship between the curative effect and the factors were analyzed,such as preoperative B-ultrasonography, intraoperative vitreous configuration , the relationship between the vitreous and the retina, the diversification of subretinal hemorrhage and CNV, the relationship between the disease duration and postoperative effect,the ralationship between surgery and postoperative effect.The group was divided into two groups based on disease course: A group,the time from vitreous hemorrhage to vitrectomy is less than 6 months;B group, the time from vitreous hemorrhage to vitrectomy is longer than 6 months.The research results: In the preoperative B-ultrasonography results of 32 cases, B-ultrasonography found that, in addition to a large number of lighe spots in the vitreous,thickening、rough、and disco-intumesce of eyeball wall in the region of macular,and the fracture between disco-intumesce and the posterior eyeball wall could also be found in 30 cases of preoperative B-ultrasonography; During the vitrectomy ,subretinal hemorrhage were seen in all patients ,in addition to two patients of subretinal hemorrhage with less extensive, the remaining patients had a greater range of subretinal hemorrhage, even to the fundus area of the 1 / 2 or more. As compared with the same age group,the posterior vitreous detachment was rare , the vitreous liquefaction was less, and adhesion of the vitreous to retinal could be easily seen. During the follow-up,it was found that,subretinal hemorrhage was gradually absorbed, CNV would began to atrophy, or finally came into scar.In addition to postoperative hyphema and high intraocular pressure , there were no obvious complications.These complications were cured after treatment, making no influence for prognosis. The statistical analysis in the preoperative visual acuity between A group and B group found that, there was no statistical significance(P﹥0.05),there were no relationship between preoperative visual acuity and disease course. The statistical analysis between preoperative visual acuity and postoperative visual acuity found that ,there was statistical significance(P﹤0.05),vitrectomy can improve postoperative visual acuity. The statistical analysis in the postoperative visual acuity between A group and B group found that, there was statistical significance(P﹤0.05), the duration was longer, the postoperative visual acuity was worse.Through the clinical data of patients in this group research, we can find: B-mode ultrasonography is a simple and an effective way for the diagnosis in patients with subretinal hemorrhage and vitreous hemorrhage. Subretinal hemorrhage is characterized by thickening、rough、and disco-intumesce of eyeball wall in the region of macular,and characterized by the fracture between disco-intumesce and the posterior eyeball wall. Simple vitrectomy is an effective method for treatment of vitreous hemorrhage caused by age-related macular degeneration,with better visual acuity and fewer complications. After vitrectomy for vitreous hemorrhage caused by AMD, choroidal neovascularization woule be atrophing、scarring, and no recurrence appear. The duration of preoperative in patients with vitreous hemorrhage caused by AMD is longer, the postoperative visual acuity is worse.In short, for the age-related macular degeneration in patients with vitreous hemorrhage, vitrectomy is a simple and an effective method for treatment, postoperative visual acuity is improved, fewer complications appeares, and choroidal neovascularization will be atrophing, scarring, and no recurrence appear, and the state of the illness is stable.
|