全玻璃体切除术治疗巨大裂孔视网膜脱离的临床效果观察  

Clinical efficacy of total vitrectomy for retinal detachment second to giant retinal tear

作　　者：张英[1] 张至菲[2] 刘文[2] 黄素英[2] 

机构地区：[1]湖南省常德市第一人民医院眼科,415000 [2]中山大学中山眼科中心,广州510060

出　　处：《眼科》2014年第3期205-209,共5页Ophthalmology in China

摘　　要：目的观察全玻璃体切除手术治疗巨大裂孔视网膜脱离的效果。设计回顾性病例系列。研究对象2003年7月至2008年1月连续在中山眼科中心就诊的原发性巨大裂孔视网膜脱离患者17例（17眼）。方法对所有17例（17眼）患者行全玻璃体切除手术治疗，术中做充分的全玻璃体切除，剥离粘连玻璃体皮质，重水压平视网膜后，切除视网膜裂孔后缘翻卷的边，眼内光凝，气饭交换和硅油填充。术中3例切除裂孔前瓣，9例切除合并裂孔前瓣的睫状体非色素上皮脱离。联合环扎1例，行晶状体咬切1例。术后平均随访24．5±8．5个月，观察视力、视网膜平伏情况及并发症，并作相应处理。主要指标视力、视网膜平伏情况及并发症。结果其中1例术后出现新裂孔，另1例术后7个月玻璃体增生牵拉导致视网膜脱离，其余15例患者在术后2～18个月顺利取出硅油，视网膜保持复位。失访1例。最后一次随访最好矫正视力：光感-指数2例，0．02±0．35例，0．5±0．76例，≥1．03例，与术前相比明显好转（χ2=17．01，P〈0．05）。结论平均随访2年的结果显示，全玻璃体切除术、部分视网膜切除、眼内光凝和硅油填充治疗巨大裂孔性视网膜脱离具有较好的手术效果。Objective To determine the effectiveness of total vitrectomy in the management of giant retinal tears （GRTs）. Design Retrospective case series. Participants Seventeen eyes of 17 consecutive patients with GRTs were enrolled at Zhongshan Ophthalmic Center from Jul. 2003 to Jan. 2008. Methods All patients were performed total vitrectomy, peeling off the adhesion cortical vitreous, perfluorocarbon liquid, partial retinectomy, endophotocoagulation, gas-liquid exchange and silicone oil tamponade. Nine eyes with ciliary epithelium detachment underwent resection of the detached ciliary epithelium. Scleral circling was placed in one eye with serious PYR. Pars plana lensectomy was performed in one eye with complicated cataract. The following-up times were 24.5±8.5 months. Main Outcome Measures The postoperative visual acuity, retinal attachment and complications. Results Retinal redetachment occurred in two patients. One with the occurrence of a new tear, the other one with serious postoperative PVR leading to tractional retinal detachment. The silicone oil was uneventfully removed in 15 patients between 2 and 18 monthes. One case was loss to follow-up. The final best-corecting visual acuity was light perception to counting fingers in 2 eyes, 0.02-0.3 in 5 eyes, 0.5 -0.7 in 6 eyes, ≥ 1.0 in 3 eyes, The postoperative visual acuity was better than preoperation （χ2=17.01,P〈0.05）. Conclusion There is a favorable effect on the retinal detachment associated with GRTs of total vitrectomy, partial retinectomy, endophotocoagulation and tamponade of silicone oil during 2year following-up.

关 键 词：巨大裂孔 视网膜脱离 玻璃体切除术 视网膜切除 硅油填充 

分 类 号：R779.6[医药卫生—眼科]