孔源性视网膜脱离对侧眼无症状视网膜裂孔的预防性治疗  

Prophylactic retinopexy for asymptomatic retinal breaks in fellow eyes of rhegmato-genous retinal detachment

作　　者：罗毅[1] 李敏[1] 赵昕[1] 吴学今[1] 

机构地区：[1]广西壮族自治区人民医院眼科,中国广西壮族自治区南宁市530021

出　　处：《国际眼科杂志》2008年第1期164-166,共3页International Eye Science

摘　　要：目的:探讨孔源性视网膜脱离患者的对侧眼无症状视网膜裂孔预防性激光光凝的疗效。方法:用三面镜和间接眼底镜观察孔源性视网膜脱离患者的对侧眼,对917例无症状视网膜裂孔进行预防性激光光凝术,记录其年龄、性别、屈光状态、晶状体的状态、对侧眼玻璃体状态、裂孔的类型和位置、预防性治疗的方法;术后随诊时间6mo～5a;记录术后视网膜和玻璃体的情况,视网膜新裂孔或视网膜脱离形成的例数,形成的时间和新裂孔发生时玻璃体的状态、新发生裂孔的类型和位置、治疗的方法。结果:孔源性视网膜脱离对侧眼裂孔发生的危险因素与年龄、性别、近视、部分玻璃体后脱离(posterior vitreous de-tachment,PVD)高度相关,裂孔以变性萎缩孔多见,马蹄孔次之;裂孔常发生的位置依次是颞上、颞下、鼻上、鼻下象限。术后发现对侧眼视网膜新裂孔或视网膜脱离形成共21例(2.3%),形成的时间平均为21.6mo(7d～3a),平均年龄41.3岁,15例(71.4%)为男性,全部为近视眼,其中16例(76.2%)高度近视(大于6.00D),全部为有透明晶状体眼,病变类型:15例(71.4%)为变性萎缩孔,6例(28.6%)为马蹄孔伴随广泛视网膜格子样变性(变性区大于6个钟点),术前部分PVD2例(9.5%),无明显的色素颗粒。新裂孔或视网膜脱离形成后,部分PVD伴色素颗粒18例(85.7%),全部均为马蹄形裂孔,马蹄孔伴后缘卷边2例(9.5%),9例(42.9%)新裂孔形成的位置位于激光光凝区的边缘,12例(57.1%)位于正常或未治疗的视网膜上,发展为视网膜脱离18例(85.7%),累及黄斑6例(28.6%),16例行视网膜裂孔冷凝联合巩膜环扎和外加压术,2例行玻璃体切除联合惰性气体填充术;单纯视网膜裂孔3例(14.3%),再次行氩激光光凝术,术后平均随访6mo。结论:孔源性视网膜脱离患者的对侧眼无症状视网膜裂孔预防性激光光凝疗效好;中青年高度近视不伴随PVD是对侧眼无症状视网膜AIM： To investigate the effect of prophylactic treatment for asymptomatic retinal breaks in fellow eyes of patients with rhegmatogenous retinal detachment. METHODS： Fellow eyes were observed with three-mirror contact lens and indirect ophthalmoscope. A total of 917 cases of asymptomatic retinal breaks in fellow eyes were treated with prophylactic retinopexy, and data were recorded about age, sex, refractive status, lens state, vitreous status, type and position of holes, and method of prophylactic treatment. Follow-up period ranged from 6 months to 5 years. Records were reviewed about retinal and vitreous conditions postoperatively, the number of cases who had new retinal breaks or retinal detachment, the time of formation, the vitreous status when new retinal breaks occurred, type, location and therapy for subsequent retinal breaks. RESULTS： Risk factors of asymptomatic retinal breaks in fellow eyes of rhegmatogenous retinal detachment were highly correlated with age, sex, myopia and partial posterior vitreous detachment （PVD）. The most common holes were degenerative atrophied ones; the secondly common holes were horse＇s hoof shaped ones. The common sites of holes were supratemporal, infero temporal, supranasal and inferonasal in turns. Twenty-one patients had new retinal breaks or retinal detachment subsequent to prophylactic retinopexy applied to the fellow eyes at the time of primary rhegmatogenous retinal detachment surgery. Among these 21 patients, the mean time of formation was 21.6 months （ranged form 7 days to 3 years）; the average age was 41.3 years; 15 cases were male and all myopic; 16 cases （76.2%） were high myopia （〉6. 00D） and transparent phakic eyes. The pathological types are as follows; 15 cases （71.4%） had degenerative atrophied holes;6 cases （28.6%） had horse hoof tears with extensive lattice degeneration of retina （scope〉6 clock hours）; 2 cases （9.5%） had partial PVD before the treatment but no obvious pigment granules. After formation of new reti

关 键 词：无症状视网膜裂孔 预防性激光治疗 对侧眼 

分 类 号：R774.1[医药卫生—眼科]