合并下方裂孔的复杂视网膜脱离手术治疗  

Surgery of complicated retinal detachment with inferior retinal break

作　　者：孟自军[1] 高永峰[1] 王艳婷[1] 

机构地区：[1]河南省眼科研究所河南省立眼科医院,郑州450003

出　　处：《中国实用眼科杂志》2013年第10期1274-1277,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨不联合巩膜扣带术的玻璃体切除术，治疗合并下方裂孔的复杂视网膜脱离的安全性及有效性。研究辅助的巩膜扣带术在合并下方裂孔的复杂视网膜脱离手术中的应用价值。方法回顾性系列病例研究。选择符合条件的复杂视网膜脱离的病人134例（135只眼），其中74例（75只眼）行玻璃体切除及硅油填充术同时联合巩膜扣带术（PPV＋SB组），60例（60只眼）行玻璃体切除及硅油填充术（PPV组），比较两组患者的手术疗效及并发症的发生情况。结果PPV＋SB组与PPV组初始手术成功率分别为97．3％（73／75）、86．7％（52／60），差异有统计学意义（Fisher精确检验，P〈0．05），两组一次及最终手术成功率差异均无统计学意义，两组各时间点视力差异亦无统计学意义（均P〉0．05）。相比于PPV＋SB组，PPV组手术时间明显缩短，但需要更多的视网膜切开，并带来了更多的医源性裂孔（P〈0．01）。结论不联合扣带术的玻璃体切除术治疗合并下方裂孔的复杂视网膜脱离是安全、有效的；辅助的巩膜扣带术可提高了合并下放裂孔复杂视网膜脱离初始手术成功率；不联合扣带术的玻璃体切除术并不能完全替代联合手术。Objective To investigate the safety and efficacy of buckled and non-buckled vltrecto-my with silicone oil tamponade in the treatment of retinal detachment with inferior breaks （IRB） and proliferative vitreoretinopathy （PVR）. To determine whether it is necessary and valuable for per-form the adjunctive scleral buckling （SB） during vitrectomy. Methods It was a retrospective case series study. A total of 135 eyes of 134 consecutive patients with IRB and PVR were alternatively assigned to the group underwent PPV and silicone oil combined with SB （PPV＋SB, n=75） or the group performed PPV with silicone oil alone （PPV, n=60）. Silicone oil was removed 3 months at lowest after surgery. Subjects were followed up for 6 months or more. The outcome and complica-tions of the two surgical proce0ures were analyzed. Results The primary incidence of reattachment of PPV＋SB and PPV alone was 97.3%, 86.7% respectively, making a significant differences （Fisher exact test, P 〈0.05）. There was no statistical difference in the first and final anatomic success rate between the two groups, and the best-corrected visual acuity （BCVA） at any time points of the two groups showed no statistical difference either （P 〉0.05）. The operative time of PPV group was low-er compared with PPV＋SB group, but needed more retinectomy and brought more iatrogenic breaks （P 〈0.01）. Conclusions Non-buckled PPV is a safe and effective surgery for retinal detachment with IRB and PVR. The assistant SB can improve and enhance primary success rates. Non-buckled PPV can not totally replace buckled PPV.

关 键 词：视网膜脱离 下方裂孔 玻璃体切除术 巩膜扣带术 增生性玻璃体视网膜病变 

分 类 号：R779.6[医药卫生—眼科]