摘要
目的探讨现代玻璃体视网膜手术治疗巨大裂孔性视网膜脱离的疗效，及提高其疗效的方法。方法回顾分析巨大裂孔性视网膜脱离50眼，其中巨大视网膜撕裂孔36眼，巨大锯齿缘截离14眼。采用现代显微玻璃体视网膜手术眼内填充的方法，其中14眼周边360°光凝；26眼注入硅油，24眼注入C3F8气体；6眼巩膜外加压及环扎。结果出院时49眼视网膜解剖复位（98.0％）；39眼随访6～36个月，视网膜解剖复位30眼（76．9％），其中7眼经过再次手术治愈，最后复位37眼（94．9％）。两组巨大裂孔性视网膜脱离治疗的疗效经统计学Fisher＇s精确概率法处理差异无统计学意义（P〈0．05）；术后主要并发症：黄斑前膜2眼，视网膜前膜4眼，视网膜裂孔2眼。结论巨大裂孔性视网膜脱离术后失败主要原因为下方增殖性玻璃体视网膜病变（proliferative vitreoretinopathy．PVR）发展和巨孔一端或下端裂孔再开放。为了提高疗效，建议术中彻底切除玻璃体，包括基底部玻璃体切除，剥净视网膜前、后增殖膜；对下方〈150°巨大裂孔，术前aPVR明显或术中增殖膜未取干净者，同时行巩膜环扎术；应用周边360°光凝，可避免术后继发视网膜再撕裂。（中国眼耳鼻喉科杂志，2008．8．301．303）
Objective To explore the therapeutic effects of micro-vitreoretinal surgery for retinal detachment with giant breaks, as well as the way to improve its curative effect. Methods A retrospective survey was done in 50 eyes with retinal detachment with giant breaks who underwent complete vitrectomy combined with intraocular tamponade. Among them, 36 eyes were diagnosed as giant retinal tear （GRT）, 14 eyes were giant dialysis （GD）. Twenty-six eyes were poured with silicone oil, 24 eyes were filled with C3 Fs , 14 eyes were applied 360° peripheral retinal photocoagula： tion. Six eyes were placed encircling buckles. Results The retinae were completely reattached in 49 eyes （98.0%）. Thirty-nine eyes were followed up for 6 to 36 months, 30 eyes （76.9%） of which remained retinal reattachment and 37 eyes （94.9%） remained retinal reattachment at last. No significant difference was found between the two groups of GRT and GD （ P 〉 0.05 ）. Postoperational complication included macular epiretinal membrane in 2 eyes, epiretinal membrane in 4 eyes and retinal tears in 2 eyes. Conclusions The failure of this kind of operation was mainly due to an inferior proliferative vireoretinopathy（PVR） and a secondary reopening of the inferior end of the GRT. To improve the therapeutic efficacy, the complete vitrectomy was recommended including removing the vitreous base and excision of the epiretinal and subretinnl membrane. In the case of 〈 150° inferior GRT or anterior PVR before operation, a simultaneous encircling buckle is recommended. The 360° peripheral retinal photocoagulation appears to be an effective way to reduce the risk of secondary tearing of the retina after the operation. （Chin J Ophthalmol and Otorhinolaryngol,2008 ,8 ：301-303 ）
出处
《中国眼耳鼻喉科杂志》
2008年第5期301-303,共3页
Chinese Journal of Ophthalmology and Otorhinolaryngology
关键词
巨大裂孔
视网膜脱离
玻璃体
Giant breaks
Retinal detachment
Vitreous body
