手术复位联合激光光凝治疗高度近视黄斑白孔性视网膜脱离  

Nd:YAG Laser for Treatment of High Myopic Retinal Detachment with Macular White Hole

作　　者：杨红[1] 孙京华[1] 陈建斌[1] 孙旭芳[1] 刘海霞[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院眼科,武汉市430030

出　　处：《中国激光医学杂志》2006年第5期302-306,共5页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的探讨高度近视黄斑白孔性视网膜脱离手术联合倍频Nd：YAG激光(532nm)治疗黄斑白孔的解剖复位和功能恢复。方法高度近视黄斑白孔性视网膜脱离患者17例17只眼,行单纯玻璃体腔注气4例,玻璃体手术联合长效气体填充3例,联合硅油填充10例,硅油取出时间平均4．9个月；黄斑孔缘视网膜光凝法7例,黄斑孔底部色素光凝法10例。术后随访时间平均11个月。结果一次手术后视网膜复位14例(82．4%),2-3次手术后视网膜复位3例(17．7%),随诊期间所有病例视网膜均复位,总复位率100%。术后视力提高者9例(9/17),占52．9%；不变者6例(6/17),占35．3%；下降者2例(2/17),占11．8%。黄斑孔缘视网膜光凝法治疗的患者中,视力提高者2例(2/7),占28．6%；视力不变者4例(4/7),占57．1%；视力下降者1例(1/ 7),占14．3%。黄斑孔底部色素光凝法治疗的患者中,视力提高者7例(7/10),占70．0%；视力不变者2例(2/10),占20．0%；视力下降者1例(1/10),占10．0%。结论高度近视黄斑白孔视网膜脱离手术复位后联合Nd：YAG激光(532nm)封闭黄斑白孔可提高手术成功率,维持或恢复视力。两种黄斑孔光凝法分别用于不同状态下的黄斑白孔均有较好疗效。Objective To investigate the therapeutic effect on eyes with high myopic retinal detachment with macular white hole treated by surgery combined with Nd:YAG laser photocoagulation. Methods Seventeen eyes of 17 patients with high myopic retinal detachment caused by maeular white hole were treated with simple vitreous gas injection(4 eyes),vitrectomy combined with gas tamponade(3 eyes)or silicone oil tamponade(10 eyes)and laser pho- tocoagulation in two ways:macular hole edge photocoagulation(7 eyes)and maeular hole bottom pigment photocoagulation(10 eyes). The follow-up period was average 11 months.The mean time of silicone oil removal was 4.9 months. Results Retinas of 14 eyes(82.4%)were reattached after one operation and 3 eyes(17.7%)after 2-3 operations.The retinas of all cases were reattached in the time of follow-up and total rate of retinal reattachment was 100%.There were 9 eyes(52.9%)whose postoperative visual acuity was increased,6 eyes(35.3%)unchanged and 2 eyes(11.8%)decreased.In the macular hole edge pho- tocoagulation there were 2 eyes(28.6%)whose postoperative visual acuity was increased,4 eyes(57.1%)unchanged and 1 eye (14.3%)decreased.In the mactdar hole bottom pigment photocoagulation there were 7 eyes(70.0%)whose postoperative visual acuitywas increased,2 eyes(20.0%)unchanged and 1 eye(10.0%)decreased. Conclusion Reattachment by surgery in conjunction with Nd:YAG laser(532 nm)photocoagulation for high myopic retinal detach- ment with macular white hole might be helpful in improving the successful rate of operation and maintain and resume visual acuity.The two photocoagulation ways could be effective on different status of macular white hole.

关 键 词：激光 视网膜脱离 视网膜穿孔 近视 

分 类 号：R778.11[医药卫生—眼科]