孔源性视网膜脱离手术复位后黄斑下积液  

Submacular fluid after surgery for rhegmatogenous retinal detachment

作　　者：沈丽君[1] 葛丽娜[1] 汪朝阳[1] 赵振全[1] 方海珍[1] 瞿佳[1] 

机构地区：[1]温州医学院附属眼视光医院,325027

出　　处：《中华眼科杂志》2008年第3期223-228,共6页Chinese Journal of Ophthalmology

基　　金：浙江省卫生厅基金资助项目（2003A068）

摘　　要：目的探讨孔源性视网膜脱离经不同复位术式后黄斑下积液发生情况。方法病例对照研究。选择手术治疗后视网膜解剖复位的新发孔源性视网膜脱离患者66例（67只眼）。按复位术式分为玻璃体切除术组和巩膜扣带术组；巩膜扣带术中因封孔方式不同和放液与否相应分为冷凝组与光凝组、放液组与不放液组。术后1个月均常规行相干光断层扫描（OCT），了解黄斑下积液的发生情况。结果玻璃体切除术组和巩膜扣带术组中，黄斑下积液发生率分别为21．7％和47．7％，差异有统计学意义（x^2=4．296，P〈0．05）。在巩膜扣带术中，冷凝组与光凝组、放液组与不放液组中的黄斑下积液发生率差异均无统计学意义（x^2=0．091，1．588；均P〉0．05）；但黄斑未脱离眼与脱离眼的黄斑下积液发生率（21．1％，68．0％）差异有统计学意义（x^2=9．537，P〈0．01）。黄斑下积液眼与未积液眼术后1个月视力提高2行以上的百分比相近（80．8％，80．1％），两者的术前及术后LogMAR值差异无统计学意义（F=0．162，P=0．688）。结论玻璃体切除术后黄斑下积液发生率明显低于巩膜扣带术。在巩膜扣带术中，光凝与冷凝、放液与否等手术操作差异对黄斑下积液发生率无明显影响，但黄斑脱离眼中黄斑下积液发生率较高。Objective To evaluate the accumulation of submacular fluid after surgery for retinal detachment. Methods It was a case control study. Sixty seven eyes of sixty six patients with rbegmatogenous retinal detachment which had undergone par plana vitrectomy （PPV）or buckle surgery for retinal detachment were recruited. All patients underwent clinical examination, optical coherence tomography （OCT） scan of the macular at the 1-month postoperative follow-up examination. Results Submacular fluid after PPV occurred in 21.7% eyes, and was significantly lower than that after buckle surgery（47.7% ,x^2 = 4. 296, P 〈 0.05 ）. No significantly differences of submaeular fluid rate were found between different surgical technique groups （cryotherapy, transscleral diode photocoagulation, with or without drainage of subretinal fluid） in our buckle surgery series （ x^2 = 0. 091,1. 588; P 〉 0. 05 ）. There was statistically significant difference in the rate of submacular fluid in cases of buckle surgery series with or without macular detachment （x^2 = 9. 537 ,P 〈0. 01 ）. Visual acuity improved for 2 lines or more accounted for 80. 8% eyes in patients with submacular fluid and for 80. 1% eyes in patients without submacular fluid. Comparison of pre- and postoperative LogMAR between these two groups showed no significant difference （ F = 0. 162, P = 0. 688 ）. Conclusions The rate of submacular fluid is much lower after PPV than after buckle surgery. Different surgical techniques used in buckle surgery such as cryotherapy or transscleral diode photocoagulation and with or without drainage of subretinal fluid do not influence the rate of postoperative submacular fluid. The rate of submacular fluid is much lower in eyes without macular detachment than in eyes with macular detachment in buckle surgery series. （Chin J Ophthalmol, 2008,44：223-228）

关 键 词：视网膜脱离 玻璃体切除术 巩膜扣带术 手术后并发症 黄斑水肿 囊样 

分 类 号：R686[医药卫生—骨科学]