方法：选择34例35眼病变范围大同时伴大面积黄斑区视网膜下积血的隐匿性CNV患者，分为A和B组。A组疗法分别为黄斑下积血和CNV取出术、bevacizumab玻璃体腔注射、bevacizumab玻璃体腔注射联合光动力疗法(PDT)、激光光凝。B组为黄斑下积血和CNV取出术基础上，行自体RPE与Bruch膜复合体移植，术后联合bevacizumab玻璃体腔注射。所有患者记录治疗前与治疗结束后随访期间最佳矫正视力(BCVA)、眼压(IOP)、检眼镜下眼底情况、眼底血管造影(FFA和ICGA)、光学相干断层扫描(OCT)、多焦视网膜电图(mfERG)等检查情况。

结果：治疗结束后随访11.7±6.5mo，B组BCVA较手术前提高10例10眼(71.43%，10/14)，不变2例2眼(14.29%， 2/14)，下降2例2眼(14.29%，2/14)，均未见CNV复发。B组BCVA 4.3±1.1，较其治疗前(3.5±0.4)有提高(P<0.05)，与A组治疗结束后BCVA(3.4±0.3)比较也有提高(P<0.05)。B组OCT后极部视网膜平均厚度236±71μm，较治疗前(371±97μm)有下降(P<0.05)，与A组治疗结束后(364±86μm)比较也有下降(P<0.05)。

结论：对于病变范围大同时伴大面积黄斑区视网膜下积血的隐匿性CNV，自体RPE与Bruch膜复合体移植联合bevacizumab玻璃体腔注射治疗有较好近期效果，是挽救此类患者视力的积极手段之一。

METHODS: A retrospective study was performed in 34 patients(35 eyes)with the massive occult CNV accompanied by the wide-ranging subretinal hemorrhage that underwent different treatment and related literatures were reviewed. The 34 patients(35 eyes)were divided to group A(the treatment methods include the macular subretinal hemorrhage and CNV removal surgery, intravitreal injection of bevacizumab, combination of PDT and intravitreal injection of bevacizumab, laser photocoagulation)and group B(transplantation of autologous RPE-Bruch membrane complex and intravitreal injection of bevacizumab). The outcome was measured before and after therapy by best-corrected visual acuity(BCVA), intraocular pressure(IOP), multifocal ERG(mfERG), optical coherence tomography(OCT), fluorescein angiography(FFA), indocyanine green angiography(ICGA). Autofluorescence tests were also conducted.

RESULTS: During 11.7±6.5 months of follow-up after the end of therapy, the BCVA of group B was elevated in 10 eyes(71.43%, 10/14), constant in 2 eyes(14.29%, 2/14)and decreased 2 eyes(14.29%, 2/14). Besides, no recurrent CNV in group B was found. The BCVA of group B was 4.3±1.1, improving significantly compared with 3.5±0.4 of group B before therapy(P<0.05)and 3.4±0.3 of group A after the end of therapy(P<0.05). The posterior pole retinal average thickness measured by fast macular scans using OCT of group B was 236±71μm, decreasing notably compared with 371±97μm of group B before therapy(P<0.05)and 364±86μm of group A after the end of therapy(P<0.05).

CONCLUSION: The short-term results of transplantation of autologous RPE-Bruch membrane complex and intravitreal injection of bevacizumab are confirmed and it could increase the visual acuity of patients with the massive CNV accompanied by the wide-ranging subretinal hemorrhage. This positive intervention should be noted in order to save the visual function of such patients.