人工晶状体眼视网膜脱离的临床特征及其治疗观察  

Surgical efficacy and clinical features of pseudophakic retinal detachment

作　　者：王雨生[1] 田超伟[1] 窦国睿[1] 李曼红[1] 张自峰[1] 

机构地区：[1]第四军医大学西京医院眼科全军眼科研究所,西安710032

出　　处：《临床眼科杂志》2014年第3期203-207,共5页Journal of Clinical Ophthalmology

摘　　要：目的探讨人工晶状体眼视网膜脱离的临床特点及手术效果。方法回顾性分析2010年8月至2013年3月间在我院住院行手术治疗的56例(56只眼)人工晶状体眼视网膜脱离患者的临床资料。其中男27例(27只眼),女29例(29只眼)。年龄7~77岁,平均47.5岁。病史2 d^6个月。所有视网膜脱离患者均为后房型人工晶状体。术前视力:光感~指数者34只眼,0.02~<0.1者10只眼,0.1~<0.2者6只眼,0.2~<1.0者6只眼。增生性玻璃体视网膜病变(PVR)分级:PVRB级37只眼,PVRC1~C3级16只眼,PVRD级3只眼。术前26只眼发现明确视网膜裂孔(其中黄斑裂孔或黄斑裂孔合并有周边孔的5只眼,其余21只眼)。33只眼后囊膜完整,23只眼后囊膜不完整或悬韧带离断(4只眼伴有人工晶状体偏移)。行巩膜外垫压(或联合环扎)9只眼,占16.1%。单纯玻璃体内注气1只眼,占1.8%。玻璃体切割手术46只眼,占82.1%,其中硅油填充38只眼(67.9%),长效气体C3F8填充8只眼(14.3%)。玻璃体手术中5只眼术中人工晶状体取出。结果术后随访3个月~2年。最终矫正视力:光感~指数者25只眼,0.02~<0.1者16只眼,0.1~<0.2者8只眼,0.2~<1.0者7只眼。行巩膜外垫压(或联合环扎)的9只眼中8只眼视网膜复位良好,1只眼视网膜复位不良再次行玻璃体手术并硅油填充后复位。单纯玻璃体内注气的1只眼视网膜复位良好。玻璃体手术并硅油填充的38只眼中3只眼术后2周内硅油进入前房,行前房穿刺部分硅油取出后前房仍有硅油滴,3个月后硅油完全取出。最终12只眼取出硅油,其中11只眼视网膜复位良好,1只眼视网膜脱离复发再次硅油注入后视网膜仍复位不良硅油维持。26只未取出硅油者4只眼视网膜复位不良,其余患者硅油未见明显乳化,无其他严重并发症发生。玻璃体手术并C3F8填充的8只眼中,7只眼视网膜复位良好,1只眼视网膜复位不良再次硅油填充复位。一次手术后50只眼(89.2%)视网膜复位良Objective To investigate the clinical features and surgical efficacy of pseudophakic retinal detach -ment.Methods The clinical data of 56 patients （56 eyes） with pseudophakic retinal detachment who were treated in our hospital between August 2010 and March 2013 were reviewed.There were 27 males and 29 females.Average age was 47.5 （range 7-77 years）.The duration of retinal detachment at presentation varied from 2 days to 6 months.All patients were implanted with posterior chamber intraocular lens .The preoperative visual acuity was light perception to finger count in 34 eyes, 0.02 to 0.1 in 10 eyes, 0.1 to 0.2 in 6 eyes, and 0.2 to 1.0 in 6 eyes.Proliferative vitreo retinopathy （ PVR） grading was PVR stage B in 37 eyes, stage C1 to C3 in 16 eyes, and stage D in 3 eyes.Retinal tears were confirmed in 26 eyes before surgery （macular hole or macular hole overlapped with peripheral tears in 5 eyes）.Thirty-three eyes had intact posterior capsule, while 23 eyes presented with incomplete posterior capsule or broken ciliary zonule （4 eyes with IOL dis-location）.These patients were treated with scleral buckling with or without cerclage （9 eyes, 16.1%）, simple gas tam-ponade （1 eye, 1.8%）, or vitrectomy （46 eyes, 82.1%） with silicon oil tamponade （38 eyes, 67.9%） or C3F8 tampon-ade （8 eyes, 14.3%）.IOL was taken out in 5 eyes during vitrectomy surgery .Results The follow-up period ranged from 3 months to 2 years.The final BCVA was light perception to finger count in 25 eyes, 0.02 to 0.1 in 16 eyes, 0.1 to 0.2 in 8 eyes, and 0.2 to 1.0 in 7 eyes.Among 9 eyes that treated with scleral buckling , re-attachment was achieved in 8 eyes.In 1 eye we turned to vitrectomy with silicon oil tamponade later because of incomplete attachment .The eye treated＆amp;nbsp;with simple gas tamponade successfully achieved re-attachment.In 38 eyes received vitrectomy and silicone oil tamponade , anterior chamber leakage was observed in 3 eyes within 2 weeks.Silicone oil was partially removed through immedia

关 键 词：人工晶状体眼 视网膜脱离 

分 类 号：R779.6[医药卫生—眼科]