黄斑裂孔视网膜脱离的手术治疗  

Therapeutic effect of surgical treatment on the retinal detachment with macular hole

作　　者：翟彦君[1] 

机构地区：[1]山东省东营市胜利油田中心医院眼科,257034

出　　处：《临床眼科杂志》2010年第6期505-507,共3页Journal of Clinical Ophthalmology

摘　　要：目的分析黄斑裂孔视网膜脱离的手术方法及效果。方法黄斑裂孔视网膜脱离26例(26只眼),术前常规检查视力、眼压、屈光情况,眼底检查采用三面镜和间接眼底镜,查明玻璃体液化情况以及有无后脱离,黄斑孔有无牵引,膜增生情况,周边视网膜是否伴有裂孔,脱离范围、程度,并以此为依据来决定手术方式。选择脱离范围局限于后极部、伴有玻璃体后脱离、无明显膜形成以及无黄斑孔牵引者,行单纯的玻璃体腔内注入惰性气体C3F8者0.5～0.8ml,4只眼行此手术;选择黄斑裂孔伴有周边裂孔,视网膜脱离范围较广泛者16只眼行巩膜外垫压必要时环扎加玻璃体腔注气术,注入C3F8者0.5～1.0ml;选择膜增生明显、脱离范围广泛、有明显黄斑裂孔牵引者8只眼(其中2只眼为二次手术)行玻璃体切割加注气术或硅油注入术。结果手术后视网膜最终复位24只眼,复位率92.3%(24/26)。单纯注气的4只眼,有1只眼气体吸收后再次脱离,脱离范围仍然比较局限,无明显增殖,经再次气体注入后复位;巩膜外垫压加必要时环扎加玻璃体腔注气术16只眼,其中3只眼再次脱离,2只眼查明有新裂孔的形成,1只眼黄斑裂孔封闭不良再次脱离,1只眼放弃治疗,2只眼进行玻璃体切割手术最终复位。玻璃体切割加注气术或硅油注入术8只眼,2只眼复发,其中1只眼为白孔,经注气失败后改为注入硅油后成功,1只眼玻璃体增生明显,造成继发裂孔,放弃治疗。手术前后视力比较,均有不同程度的提高。结论对于黄斑裂孔视网膜脱离的患者术前都要进行仔细认真地检查,依据裂孔的性质、部位、大小、脱离的范围、增生膜的情况来决定手术方式,可以减少不必要的手术损伤和并发症的发生,来获得最大的视功能的康复和视网膜的解剖复位。Objective To investigate the therapeutic effects of surgical treatment for retinal detachment due to macular hole.Methods Twenty-six eyes of 26 patients with retinal detachment due to macular hole. The patients had been examinuted by rountid Methods,including visual acuity. Intraocular pressure,refractive and ocular fundus condition before surgiced treatment. Then accroding to the condition of retinal detachment to select episcleral indent with silicone sponge,scleral encircliong or vitrectomy intravitreous filling with gas or silicone oil.Results The total final anatomical success rate was 24/26（92.3%）. 4eyes of them underwent scleral buckling. 16 eyes of scleral bucking combined with the tamping of C3F8. 8 eyes of them is retrectomy combined with the tamping of 12%C3F8 or silicone oil. Ultimate,2 eyes of them give up treats since once again postoperative recrudesce.Conclusion The patients with retinal detachment due to macular hole must be examined carefully in preoperative. Basis the gap character and location and size and the range of retinal detachment and the condition proliferating a film go to decide operation way. It can cut down operation loss and complication happening. It is beneficial to look at a function＇s recovering and good for retina＇s anatomy replacement from the illness.

关 键 词：黄斑裂孔 视网膜脱离 

分 类 号：R779.6[医药卫生—眼科]