玻璃体切除术治疗急性视网膜坏死综合征  

vitrectomy for acute retinal necrosis syndrome

作　　者：董卫红[1] 毕宏生[1] 王兴荣[1] 杜秀娟[1] 马先祯[1] 俞超[1] 

机构地区：[1]山东中医药大学眼科中心山东施尔明眼科医院,济南250002

出　　处：《中国实用眼科杂志》2009年第9期1032-1034,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨玻璃体切除术治疗急性视网膜坏死综合征的手术时机、手术方法并评价其疗效。方法选取2005年1月至2008年6月经玻璃体切除术治疗急性视网膜坏死综合征的26例31只眼。单眼21例，双眼5例。自发病至手术时间为半个月至6个月。所有患者均给予无环鸟苷及糖皮质激素治疗，对于药物治疗病情无好转或就诊时已有严重的玻璃体混浊或已并发视网膜脱离患者，及时进行玻璃体切除手术。术中彻底切除混浊的玻璃体，包括用巩膜顶压法或在全视网膜镜下切除基底部玻璃体，对于视网膜表面的较厚渗出物用笛针仔细予以吸除，仔细剥离、切除视网膜前增殖膜，对于有视网膜脱离者注入重水压平视网膜，光凝封闭视网膜裂孔及坏死萎缩的视网膜区，气液交换后行C2F6、C3F8或硅油填充玻璃体腔。硅油填充眼视眼部情况择期行硅油取出术。观察炎症控制情况及视网膜复位、视力恢复情况。随访期为6个月至2年。结果随访期间所有病例炎症均控制良好，单眼发病患者对侧眼未出现发病。25只眼（80．65％）视力有不同程度改善，其中18只眼视力≥0．1，占58．06％，最好视力为1．0。视网膜完全复位者28只眼，占90．32％；视网膜部分复位、硅油维持眼2只眼；低眼压、硅油维持眼1只眼。结论对于急性视网膜坏死病情严重者，选择合适的手术时机、及时进行玻璃体切除手术治疗，可有效控制病情发展、挽救患者的视功能。Objective To explore the therapeutic timing and methods of vitectomy for acute retinal necrosis syndrome and evaluate the therapeutic effects.Methods Twenty-six cases（31 eyes） which were diagnosed as acute retinal necrosis syndrome were treated with vitrectomy from January, 2005 to June, 2008 in our hospital.All the patients were treated with （acyclovir, ACV） and corticoid hormones.Those with severe vitreous opacity or retinal detachment were treated with vitrectomy in time, combined with photocoagulation, C2F6, C3F8 or silicone oil tamponade.Followed up from 6 to 24 months, the ocular inflammation, retina and vi- sual acuity were observed.Results The ocular inflammation of the 31 eyes was all successfully controlled. Retinas were completely attached in 28 eyes （90.32%）.The visual acuity was improved in 25 eyes （80.65%） in different degrees and reached 0.1 or better in 18 eyes （58.06%）.The best acuity was 1.0.Conclusions Acute retinal necrosis syndrome is a severe disease; retinal detachment is the most severe complication.For those severe cases, vitrectomy is an effective and important management to reattach the retinas and improve the visual acuity.

关 键 词：急性视网膜坏死 视网膜脱离 玻璃体切除 手术治疗 

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