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Rinsho Ganka Volume 40, Issue 2 （February 1986）

臨床眼科 40巻2号（1986年2月発行）

Japanese English

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特集第39回日本臨床眼科学会講演集　（1）

学会原著

片眼性硝子体出血の原因と対策 Causes and prognosis of unilateral massive vitreous hemorrhages 新田安紀芳 ¹ , 南部真一 ¹ Akiyoshi Nitta ¹ , Shinichi Nambu ¹ ¹群馬大学医学部眼科学教室 ¹Dep. of Ophthalmol., Sch. of Med. Gunma Univ. pp.91-95

発行日 1986年2月15日 Published Date 1986/2/15

DOI https://doi.org/10.11477/mf.1410209603

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Abstract 文献概要
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　糖尿病性網膜症を除く片眼性に突発した大量硝子体出血151例を検索した．網膜裂孔（42％）と陳旧性網膜静脈分枝閉塞症（37％）が2大原因を占めた．一般に自然予後は不良であった．裂孔群64例中発症後1カ月過ぎてから剥離手術を行った32例は，復位率64％と不良で，その大きな原因は，増殖性硝子体網膜症の合併であった．網膜静脈分枝閉塞症など網膜血管病変の場合，出血の自然吸収は38％と低いうえに，2カ月以後の吸収例は極端に少なく，出血が持続した．また網膜静脈分枝閉塞症やイールズ病に網膜裂孔が18％と高率に合併した．片眼性硝子体出血をみた時には，網膜裂孔の発見と増殖性硝子体網膜症予防のために遅くとも1カ月以内に硝子体手術を行うことが勧められる．

　一方，網膜静脈分枝閉塞症など網膜血管病変が考えられる場合には，2カ月待っても出血が消退しなければ硝子体手術の適応があると結論される．

We evaluated a consecutive series of 151 eyes with massive vitreous hemorrhage affecting one eye only. Vitreous hemorrhage related to diabetic retinopathy or ocular perforating injuries were not included in the study. We paid particular attention to the causes, clini-cal course and therapeutic implications.

The causative factors for the vitreous hemorrhage could be identified in all the cases, either through vitre-ous surgery (74 eyes) or spontaneous resorption (77eyes). There were two major factors for the vitreoushemorrhage : retinal tear formation (42%) and long-standing branch retinal vein occlusion (BRVO) (37%).Rhegmatogenous retinal detachment was a common consequence of vitreous hemorrhage due to retinal tear. Surgical outcome of these eyes were not very favorable, as proliferative vitreoretinopathy (PVR) of Grade B or more was present in 38% of the cases when the detach-ment was detected and operated on after the vitreous hemorrhage had persisted for one month or longer. Macular pucker or persistent retinal fold in the macula were chief factors for poor visual acuity in spite of anatomical reattachment.

Vitreous hemorrhage due to long-standing BRVO was characterized by recurrent vitreous hemorrhage and, therefore, by poor tendency for spontaneous resorption. The vitreous cleared in only 38% of eyes within 6 months after the initial episode of vitreous hemorrhage. Retinal tear formation was another serious complica-tion, developing in 11 out of 67 eyes (16%) in this group.

The present findings indicate that an early vitreous surgery is indicated for unilateral massive vitreous hemorrhage because of frequent association of poor prognostic factors as outlined above.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(2) : 91-95, 1986