黄斑裂孔性视网膜脱离的手术选择  

The options of surgical methods for retinal detachment due to macular hole

作　　者：李跃[1] 刘淑伟[2] 李玉涛[2] 

机构地区：[1]辽宁医学院,锦州121001 [2]唐山市眼科医院,唐山063000

出　　处：《中国实用眼科杂志》2012年第2期127-129,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨黄斑裂孔性视网膜脱离手术方式的选择.方法 回顾性临床病例分析研究.对2001年1月至2010年12月在唐山市眼科医院就诊的342例（351只眼）,接受玻璃体切除联合眼内填充术的黄斑裂孔性视网膜脱离患者的手术资料分析.结果 351只眼黄斑裂孔性视网膜脱离中,屈光度-6.00～-25.00 D,平均-13.17 D,黄斑白孔98只眼,占27.9％,伴有脉络膜脱离47只眼占13.4％,伴有后巩膜葡萄肿201只眼占57.3％,大面积后极部视网膜色素上皮或脉络膜萎缩199只眼占56.7％.手术方法采用玻璃体切除联合气体或硅油填充,气体填充80只眼占22.8％,硅油填充271只眼占77.2％.一次性解剖复位率气体为92.5％,硅油为88.9％,二者对比差异无统计学意义（x2=0.855,P ＞0.05）,351只眼中同时行白内障超声乳化人工晶状体植入术者165只眼占47.0％.结论 玻璃体切除联合气体或硅油填充是黄斑裂孔性视网膜脱离的主要手术方式,由于黄斑裂孔性视网膜脱离大多数为高度近视患者,且常伴有后巩膜葡萄肿、大面积后极部视网膜色素上皮萎缩和脉络膜萎缩,故硅油填充明显多于气体填充患者数量,同时联合白内障手术也是未来手术发展的趋势.Objective To investigate the options of surgical methods for retinal detachment due to macular hole. Methods Retrospectively analyzed 351 eyes of 342 patients with retinal detachment due to macular hole, who had undergone vitrectomy combined with inner eyes tamponade from January 2001 to December 2010. Results In 351 eyes with retinal detachment due to macular hole, diopter was from -6.00D to -25.00D （averaged -13.70D）, associated with white macular hole in 98 eyes （27.9%）, choriodal detachment in 47 eyes （13.4%）, posterior staphyloma in 201 eyes （57.3%） and the large area of posterior retinal pigment epithelium atrophy or choroidal atrophy in 199 eyes （56.7%）. Of 80 eyes underwent vitrectomy combined with gas tampanade （22.8%） and 271 eyes underwent vitrectomy combined with silicone tampanade （77.2%）; and the rates of primary ana- tomic attachment were as follows： 92.5% in the gas group and 88.9% in the silicon group, there was no statistical significant between them （χ2=0.855, P 〉0.05）. In 351 eyes, 165 eyes had undergone vitreous surgery combined with phacoemulsification and intraocular lens implantation, accounting for 47.0%. Conclusions Vitrectomy combined with gas or silicon tamponade is the major surgical method for retinal detachment due to macular hole, because most of the patients suffer from high myopia, and the disease is often accompanied by such as posterior staphyloma, the large area of posterior retinal pigment epithelium atrophy and choroidal atrophy, the number of the patients with silicon tampanade is significantly more than the number of the patients with gas tampanade, meanwhile, combining with cataract surgery is also the trend of the surgery development in the future.

关 键 词：黄斑裂孔 视网膜脱离 玻璃体切除 

分 类 号：R774.12[医药卫生—眼科]