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目的探讨非外伤性玻璃体大量积血的病因。方法对非外伤性玻璃体大量积血患者198例210只眼的病历资料进行病因分析。结果在所有患者中,视网膜静脉阻塞(retinal vein occlu-sion,RVO)导致玻璃体大量积血的患者最多,为78例79只眼占39.39%;其次为增殖型糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR),为65例72只眼占32.83%;再次为视网膜静脉周围炎和渗出型老年性黄斑变性(exudative age-related macular degeneration,EAMD),分别为19例20只眼和14例14只眼占9.59%和7.07%。少见的病因包括Terson综合征、玻璃体后脱离、视网膜大动脉瘤、高血压性视网膜病变、白血病、脉络膜恶性黑色素瘤和Coat′s病。在RVO组中,玻璃体的大量积血迟发于RVO发生时间的患者为67例(85.90%),同时发生者只有7例(8.97%),两者具有显著性差异(χ2=65.74,P<0.005)。结论RVO、PDR、视网膜静脉周围炎和EAMD是非外伤性玻璃体大量积血的主要病因。眼底新生血管的破裂和出血是多数非外伤性玻璃体大量积血的根本原因。
Objective To investigate the etiology of massive traumatic hemorrhage of non-traumatic vitreous. Methods Etiology analysis was performed on medical records of 210 eyes of 198 patients with non-traumatic vitreous hemorrhage. Results In all the patients, retinal vein occlusion (RVO) resulted in the largest number of vitreous hemorrhage, accounting for 39.39% of 78 eyes (79 eyes), followed by proliferative diabetic retinopathy PDR), accounting for 32.83% of 65 eyes (72 eyes). Again, there were exudative age-related macular degeneration (EUDD) and exudative age-related macular degeneration (EAMD) in 19 eyes and 14 eyes in 14 eyes Eyes account for 9.59% and 7.07%. Rare etiologies include Terson’s syndrome, posterior vitreous detachment, retinal aneurysm, hypertensive retinopathy, leukemia, choroidal malignant melanoma and Coat’s disease. In the RVO group, there were 67 patients (85.90%) with a large amount of hemorrhage in the vitreous, and only 7 patients (8.97%) with RVO occured at the time of onset of RVO. There was a significant difference between the two groups (χ2 = 65.74, P < 0.005). Conclusion RVO, PDR, retinal vein inflammation and EAMD are the main causes of non-traumatic vitreous hemorrhage. Ocular fundus rupture and hemorrhage is the root cause of most non-traumatic vitreous hemorrhage.