预防性周边部360°视网膜激光光凝对硅油取出手术后视网膜再脱离的影响  

The effect of prophylactic 360°laser retinopexy on retinal redetachment after silicone oil removal

作　　者：周占宇[1] 王荣荣[1] 孟旭霞[1] 吴媛[1] 

机构地区：[1]青岛大学医学院附属医院眼科,266003

出　　处：《中华眼底病杂志》2008年第4期283-285,共3页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 探讨硅油取出手术前行预防性周边部360°视网膜激光光凝对硅油取出手术后视网膜再脱离的影响。方法 对181例行硅油取出手术的各种玻璃体视网膜疾病患者的临床资料进行回顾性分析。激光光凝组88例于硅油取出手术前行预防性周边部360°视网膜激光光凝；对照组93例硅油取出手术前未行预防性视网膜激光光凝。观察2组患者硅油取出手术后视网膜再脱离发生率、发生时间、原因及激光光凝的并发症。结果 硅油眼内填充时间为4～72周，平均硅油填充时间（13.7±2.4）周。硅油取出手术后20例患者发生视网膜再脱离，其中，激光光凝组5例，占激光光凝组患者的5.7%；对照组15例，占对照组患者的16.1%。两组视网膜再脱离发生率比较，差异有统计学意义（P＜0.05）。20例视网膜再脱离患者中，再脱离发生时间≤手术后3 d者10例，4～7 d者6例，8～14 d者3例，手术后2个月者1例。11例为锯齿缘区或激光光凝区之后有被硅油暂时性封闭的遗漏小裂孔，或激光光凝、冷凝作用不足导致的原裂孔手术后重新开放；1例为预防性激光光凝手术后激光斑因受附近增生膜牵拉形成的裂孔；7例为增生性玻璃体视网膜病变或残留玻璃体牵拉形成的新裂孔；1例原因不明。激光光凝组中，有52例发生瞳孔缘激光灼伤，占激光光凝者的59.0%。结论 硅油取出手术前预防性周边部360°视网膜激光光凝与硅油取出手术后视网膜再脱离发生率下降有关联。Objective To investigate the effect of prophylactic 360°laser retinopexy on retinal redetachment after silicone oil removal. Methods The clinical data of 181 vitreoretinal patients after silicone oil removal were retrospectively analyzed. In 88 patients （photocoagulation group） was taken prophylactic 360-degree laser retinopexy before silicone oil removal; in 93 patients （control group） without prophylactic laser retinopexy. The incidence, time, the cause of retinal redetachment and the complications of laser retinopexy after silicone oil removal in two groups were observed. Results The duration of silicone oil tamponade is 4～72 weeks, averaging 13.7±2.4 weeks. 20 cases of retinal redetachment were recorded after silicone oil removal, including 5 cases （5.7%） in photocoagulation group and 15 cases （16.1%） in control group. The difference between two groups is statistically significant （P〈0.05）. Among these 20 patients with retinal redetachment, 10 occured during the first 3 days after the operation, 6 during 4～7 days, 3 during 8～14 days. 1 case occured 2 months after the operation. 11 cases of redetachment result from the omission of small retinal breaks located in ora serrata or behind the photocoagulation zone, or the reopening of primary retinal breaks because of insufficient photocoagulation and freezing during the operation. 1 case result from the hole that come from laser photocoagulation scar tracted by nearby proliferative tissue. 7 cases result from the formation of new breaks from the proliferative vitreoretinopathy（PVR） or proliferation of residual vitreous. There are 52 cases of burning of pupillary border, with the incidence of 59%. Conclusions Prophylactic 360-degree laser retinopexy is associated with a decrease of the incidence of retinal redetachment after removal of silicone oil.

关 键 词：视网膜脱离/预防和控制 视网膜脱离/外科学 激光凝固术 硅油类/治疗应用 

分 类 号：R779.63[医药卫生—眼科]