脉络膜脱离型视网膜脱离治疗的临床分析  

The clinical analysis of the treatmeant in the choroidal detachment associated with retinal detachment

作　　者：徐晶[1,2] 刘早霞[1] 

机构地区：[1]吉林大学第二临床学院眼科,长春160041 [2]大庆市人民医院眼科

出　　处：《中国实用眼科杂志》2009年第9期962-965,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨脉络膜脱离型视网膜脱离患者的手术疗效及其影响手术疗效的因素。方法回顾收治的76例（76只眼）脉络膜脱离犁视网膜脱离患者的临床资料，分析患者病程长短、术前增殖性玻璃体视网膜病变的分级、手术方式、术前糖皮质激素治疗等因素与手术疗效的关系。结果此组患者手术治愈率为71．1％，低下一般视俐膜脱离的治愈率；PVRC1～C3级为77．8％，PVRD1～D3级为61．3％；PVRC～D级中，行玻璃体切除术背的手术治愈率高于行巩膜扣带术；患者病程越长，术前PVR程度越重；术前糖皮质激素使用者比未使用者手术治愈率高；糖皮质激素使用时间的长短与手术治愈率无关。结论（1）对于PVRC级以上脉络膜脱离型视网膜脱离患者手术应首选玻璃体切除术。（2）术前使用糖皮质激素有助于提高手术的治愈率，但要掌握好用药时间，一般3～5d为宜。（3）术前糖皮质激素使用时间的长短与手术治愈率无关。（4）患者的病程越长，PVR程度越重，玻璃体切除术治疗该病的治愈率越差。（5）对于PVRC级患者采用巩膜扣带术，手术治愈率均较差。Objective To evaluate the effect of different factors on the prognosis of choroidal detachment associated with retinal detachment. Methods The clinical data of 76 eyes of 76 patients＇ were studied retrospectively from Jan, 2001 to Jan, 2007. The relationship between the successful rate and the factors was analyzed, such as the length of the course, the grade of the preoperative proliferative vitreoretinopathy, modus operandi and preoperative treatment of glucocorticoid. Results The total success rate of the surgery was 71.1% that was lower than that of general retinal detachment. In the eyes with C1 - C3 PVR, the rate was 77.8%, in the eyes with D1 -D3 PVR, the rate was 61.3%. In eyes with D1 -D3 PVR the success rate of vitrectomy was higher than that of scleral buckling alone. The course of disease was longer and the preoperative PVR became more severe. Administration of steroids before surgery can improved the success rate, but the length of time of the steroid treatment had no effect on the success rate. Conclusions 1. Vitrectomy should be preferred for the choroidal detachment associated with retinal detachment of patients in PVR C level and above. 2. Glucocorticoids application before the operation can improve the cure rate, but the time of the usage should be limited in 3 to 5 days. 3. The duration of the glucocorticoids application before the operation is unrelated with the cure rate. 4. The longer of the course and the severe of PVR before the operation will lead to the worse cure rate of the disease after the vitrectomy. 5. The cure rates are poor by the scleral buckling for C-D PVR

关 键 词：视网膜脱离 脉络膜脱离 玻璃体切除术 巩膜扣带术 

分 类 号：R774.12[医药卫生—眼科] R135.1[医药卫生—临床医学]