汤雪娥 彭小凡 傅丽萍 杨志浩 谢东文 黄晓英

摘 要 目的：观察镇静下YAG激光玻璃体后皮质切开引流术治疗新生儿黄斑区视网膜前出血的临床效果。方法：选取黄斑区视网膜前出血新生儿45例（46眼），出生后4周时在镇静状态下采用YAG激光行玻璃体后皮质切开引流术。术后随访3个月，记录患眼出血吸收、视力改善和并发症发生情况。结果：42例（42眼）出血缓慢引流入玻璃体腔，3例（4眼）因出血凝集引流失败。成功引流的42眼中，术后1周85.71%（36/42）的患眼视网膜前出血基本吸收，成功暴露黄斑中心凹，83.33%（35/42）的患眼明显追光，64.29%（27/42）的患眼明显追物；至术后3个月时，均能明显追光追物。引入玻璃体积血1～3周吸收，无玻璃体积血情况发生。结论：镇静下YAG激光辅以体位引流新生儿视网膜前出血，可有效改善患眼的追光反应，无严重并发症发生。

关键词 黄斑区 视网膜前出血 新生儿 钇铝石榴石激光

中图分类号：R779.7； R722.19 文献标志码：B 文章编号：1006-1533（2021）09-0033-03

Analysis of yAG laser for the treatment of neonatal preretinal hemorrhage under sedation

TANG Xuee， PENG Xiaofan， FU Liping， YANG Zhihao， XIE Dongwen， HUANG Xiaoying

（Department of Otology， the Central Hospital of Xinyu Iron and Steel Group Co.， Ltd.， Jiangxi Xinyu 338000， China）

ABSTRACT Objective： To observe the clinical curative effect of YAG laser posterior vitreous cortex （PVC） incision and drainage under sedation on neonatal preretinal hemorrhage in macular area. Methods： Forty-five neonates （46 eyes） with preretinal hemorrhage in macular area were enrolled and underwent PVC by YAG laser under sedation four weeks after birth. They were followed up for 3 months after surgery. The hemorrhage absorption of affected eyes， visual acuity improvement and complications were recorded. Results： There were 42 cases （42 eyes） with hemorrhage and slow drainage into vitreous cavity， and 3 cases （4 eyes） with drainage failure due to hemorrhage agglutination. Among 42 eyes with successful drainage， preretinal hemorrhage of 85.71% （36/42） of affected eyes were basically absorbed at one week after surgery， with successful exposure of macular fovea， 83.33% （35/42） of affected eyes with significant light following， 64.29% （27/42） of them with significant objects following. At 3 months after surgery， all could significantly follow light and objects. After the vitreous introduced， hemorrhage was absorbed after 1-3 （1.87±0.54） weeks. There was no vitreous hemorrhage. Conclusion： The application of YAG laser assisted with postural drainage under sedation in neonatal preretinal hemorrhage can effectively improve light following response of affected eyes without serious complications.

KEy WORDS macula area； preretinal hemorrhage； neonate； YAG laser

隨着新生儿眼病筛查的普及，新生儿视网膜出血确诊率明显提高[1]。研究表明[2-4]，早产、头位、胎头吸引、妊娠高血压等是新生儿视网膜出血的危险因素。对于大多数的Ⅰ级、Ⅱ级及部分Ⅲ级出血在2～4周内吸收，且吸收后不留痕迹，临床以观察为主。黄斑区大量的视网膜前出血吸收过程长，延长至数周至数月。新生儿视觉发育不成熟，黄斑区大量出血即使后期出血吸收不留痕迹，也可能引起患眼不可逆的视功能损害，可能导致儿童时期发生斜视、弱视、眼球震颤、屈光参差等[5]。……