Objective To investigate the therapeutic effects of retinal angiomatosis in differentclinical stages.To discuss the indication of vitrectomy for retinal hemangioblastoma. Methods TheclinicaI data of 22 cases(33 eyes)were retrospectively analyzed.The retinal hemangiomas were dividedinto 5 stages according to their degrees of development from simple angioma without vessel dilation tofeeder vessel dilation and intra-retinal exudates.local retinal detachment,massive retinal detachment andcomplication occurrence in proper order.The methods of treatment were laser photocoagulation,trans-scleral cryotherapy and vitrectomy. 13 eyes were treated with laser photocoagulation, 5 eyes withcryotherapy combined with laser and 11 eyes with vitrectomy.Tumor resection and silicone oil tamponadewas performed in 3 eyes during vitrectomy.The patients were followed up for 46 months on average.Visual acuity(VA),the condition of the hemangioma and retina was compared pre～and post-operationrespectively. Results In a11 13 eyes treated with laser phot.coagulation the hemangiomas regressed andthe retina remained attached.VA improved in 2 eyes,and remained unchanged in 11 eyes.Cryotherapycombined with laser photocoagulation was performed on 5 eyes. In this group,4 eyes'hemangiomasregressed and no new hemangiomas occurred,proliferative vitreous retinopathy and vitreous hemorrhagewas observed in 1 eye which vitrectomy was performed later.VA improved in 2 eyes,unchanged in 2 eyesand decreased in 1 eye.In the 11 eyes treated with vitreoretinal surgery,new hemangiomas was found in 1eye,exudative retinal detachment was caused by hemangiomas in 2 eyes,proliferative vitreous retinopathywas observed in 2 eyes.and the retina remained attached in 8 eyes.VA improved in 3 eyes,unimproved in3 eyes,and decreased in 5 eyes.In the 3 eyes with surgical resection of retinal hemangioma during vitrectomy,2 eyes'retina remained attached,1 eye had exudative retinal detachment and no new hemangiomas occurred.VA improved in 2 eyes and decreased in 1 eye. Conclusions Laser photocoagulation or combined with cryotherapy is effective in treating the hemangiomas in early stage.Vitreetomy is advisable for late stage of retinal angiomatosis,especially with vitreous hemorrhage,epiretinal membrane,proliferation and large scale of retinal detachment.Surgical resection of isolated large retinal hemangioblastoma may be useful for selected patients.%目的 观察不同临床分期的视网膜血管瘤采用激光光凝、冷冻、玻璃体视网膜手术以及瘤体切除等方法治疗的临床效果,探讨玻璃体视网膜手术治疗的适应证.方法 回顾分析22例视网膜血管瘤33只患眼治疗前后的临床资料.治疗前按照视网膜血管瘤有无明显扩张供养血管、周围渗出、局限性视网膜脱离、广泛视网膜脱离至晚期并发症的过程,将本病分为5期.其中13只患眼主要采用单纯激光光凝治疗;5只患眼主要采用冷冻联合激光光凝治疗;11只眼患眼采用玻璃体视网膜手术治疗,其中3只眼同时进行了视网膜血管瘤瘤体切除治疗.治疗后平均随访时间46个月,对比分析患者治疗前后视力、视网膜血管瘤以及视网膜等情况.结果 单纯激光光凝治疗的13只眼视网膜血管瘤均退行萎缩,视网膜平伏,视力提高2只眼,不变11只眼;冷冻联合激光光凝治疗的5只眼中,4只眼视网膜血管瘤退行萎缩,未见血管瘤复发,1只眼出现玻璃体视网膜增生及玻璃体积血需进一步采用玻璃体视网膜手术治疗,视力提高2只跟,不变2只眼,下降1只眼;玻璃体视网膜手术治疗的11只眼中,1只眼出现新的血管瘤,2只眼血管瘤引起渗出性视网膜脱离,2只眼再次出现玻璃体视网膜增生,8只眼视网膜平伏,视力提高3只眼,不变3只眼,下降5只眼.同时进行视网膜血管瘤瘤体切除治疗的3只眼中均未见血管瘤复发,2只眼视网膜平伏,1只眼出现渗出性视网膜脱离,视力提高2只眼,下降1只眼.结论 单纯激光光凝或联合冷冻治疗对早期视网膜血管瘤患者有效;对伴有玻璃体积血、视网膜前膜形成、增生明显、视网膜脱离范围大的晚期视网膜血管瘤病变宜采用玻璃体视网膜手术治疗,视网膜血管瘤瘤体切除可有选择性应用,其远期效果仍有待观察.
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