关键词: 息肉状脉络膜血管病变, 玻璃体积血, 玻璃体切除术

Abstract: Objective To describe the outcomes and related effective factors of pas plana vitrectomy (PPV) for vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV). Design Retrospective case series. Participants 294 eyes of 294 cases with VH secondary to PCV that underwent PPV from 2012 to 2020 in Beijing Tongren Hospital. Methods Medical records of all 294 patients were reviewed, including demographics and clinical characteristics of patients，different intraocular tamponades and visual acuity prognosis. The related factors of visual acuity prognosis including demographics and clinical characteristics of patients, systemic dieaseses, application of anti-vascular endothelial growth factor (VEGF) and surgery related data were also analyzed. Logisic analysis was used for studying related factors of visual acuity prognosis. The median of follow-up period was 120 days (range 90~750 days). Main Outcome Measures LogMAR best corrected visual acuity（BCVA）, application of anti-VEGF or not, duration of surgery, incidence of intraoperative retinal hole, proportion of retinotomy, different intraocular tamponades. Results The mean logMAR BCVA before PPV (2.22±0.47, 0.3~2.9) had improved significantly at the last visit after the operations (1.66±0.64, 0.1~1.85) (P<0.0001). Diabetes might be associated with poor postoperative BCVA (P=0.0375). In the patients without anti-VEGF treatment before PPV, the incidence of intraoperative retinal hole and the proportion of inert gas or silicon oil tamponade were higher (P=0.015). Compare with patients with BSS or air tamponade, patients with inert gas or silicon oil tamponade had lower proportion of anti-VEGF treatment (27.50% VS 48.03%, P=0.0150) , lower rate of posterior vitreous detachment (PVD) preoperatively (27.50% VS 53.94%, P=0.043), but had higher incidence of intraoperative retinal hole (50.00% VS 1.97%) , higher proportion of retinotomy (30.00% VS 0.00%) during surgery (all P<0.001), longer surgery duration (102.33±58.78 VS 50.7±22.16, P<0.0001), and poorer postoperative logMAR BCVA （1.86±0.62 VS 1.63±0.64，P=0.0352）. Conclusion PPV is effective for VH patients secondary to PCV, which can improve/stabilize visual function. Preoperative anti-VEGF treatment may play a significant role in reducing intraoperative complications, reducing the proportion of silicon oil tamponade, and improving the visual prognosis. (Ophthalmol CHN, 2022, 31: 181-187)

Key words: polypoidal choroidal vasculopathy, vitreous hemorrhage, pars plana vitrectomy