摘要目的:观察息肉样脉络膜血管病变（PCV）眼内出血内外路联合手术的疗效。方法:回顾性临床研究。2018年1~8月于南昌大学第二附属医院眼科检查确诊的PCV合并玻璃体积血（VH）伴出血性视网膜脱离患者14例14只眼纳入研究。患眼平均病程为（1.12±0.68）个月；视力下降时间2~14 d；出血性视网膜脱离至手术平均时间为（6.32±2.82）d。BCVA光感、手动、数指者分别为9、3、2只眼；平均黄斑中心凹厚度（CFT）为（564.6±102.2）μm。视网膜脱离范围累及≥2个象限。采用23G玻璃体切割手术清除VH，经巩膜外路引流排出视网膜下积血，复位视网膜。手术后1周和1、2个月，患眼玻璃体腔注射10 mg/ml雷珠单抗0.05 ml（含雷珠单抗0.5 mg ）。手术后平均随访时间为（6.24±1.16）个月。手术后1周和1、3、6个采用手术前相同设备和方法行相关检查，观察患眼BCVA、CFT、眼压、视网膜复位情况。手术前后BCVA比较采用非参数检验。结果:所有患眼VH完全清除，手术中未出现医源性视网膜裂孔。手术后6个月，患眼BCVA手动、数指、0.1、0.2、>0.2者分别为1、1、8、2、2只眼；与手术前比较，BCVA明显提高，差异有统计学意义（ Z=－3.711 ， P=0.000 ）。患眼平均CFT为（336.4±54.8）μm；与手术前比较，明显降低，差异有统计学意义（ t=3.212， P=0.006）。OCT检查可见黄斑形态结构清晰可见。14只眼中，视网膜脱离复位13只眼；硅油取出手术后视网膜再次脱离1只眼。手术后1周内眼压升高3只眼，其中前房少量积血1只眼。随访期间所有患眼未出现复发性VH。 结论:内外路联合手术治疗PCV合并VH伴出血性视网膜脱离安全、有效。

abstractsObjective:To observe the effect of combined operation of internal and external surgery for intraocular hemorrhage of polypoidal choroidal vascular disease (PCV).Methods:Retrospective clinical research. From January to August 2018, 14 eyes of 14 patients with PCV combined with vitreous hemorrhage (VH) with hemorrhagic retinal detachment confirmed by eye examination at the Second Affiliated Hospital of Nanchang University were enrolled in this study. The average disease course was 1.12±0.68 months. The visual acuity decreased from 2 to 14 days. The average time from hemorrhagic retinal detachment to surgery was 6.32±2.82 d. There were 9 eyes with BCVA of light sensing, 3 eyes of hand movement, and 2 eyes of counting fingers. The average macular foveal thickness (CFT) was 564.6±102.2 μm. The range of retinal detachment involves equal or greater than 2 quadrants. 23G vitrectomy surgery was used to remove VH, and subretinal hemorrhage was drained through external scleral drainage to reset the retina. One week and 1 and 2 months after the operation, the eyes were injected with 0.05 ml of ranibizumab in the vitreous cavity. The average follow-up time after surgery was 6.24±1.16 months. One week after the operation, 1, 3, and 6 patients were examined with the same equipment and methods before the operation to observe the condition of BCVA, CFT, intraocular pressure and retinal reattachment. Non-parametric tests were used to compare BCVA before and after surgery.Results:VH was completely cleared in all eyes, and no iatrogenic retinal hole appeared during the operation. Six months after the operation, there were 1 eye with BCVA of hand movement, 1 eye of counting fingers, 8 eyes of 0.1, 2 eyes of 0.2 and 2 eyes of over than 0.2; the average CFT was 336.4±54.8 μm. Compared with before surgery, the BCVA was significantly improved ( Z=-3.711, P=0.000), the CFT was significantly decreased ( t=3.212, P=0.006). OCT examination showed that the macular morphology and structure were clearly visible. Of the 14 eyes, 13 eyes were reattached, 1 eye was detached again after silicone oil removal. Intraocular pressure increased in 3 eyes within 1 week after surgery, including 1 eye with a small amount of blood in the anterior chamber. No recurrent VH was found in all eyes during follow-up. Conclusions:Combined internal and external surgery for PCV combined with VH with hemorrhagic retinal detachment is safe and effective.