分段巩膜外垫压手术治疗多发裂孔性视网膜脱离的临床观察  

The clinical observation of segmental scleral bulking in treatment of rhegmatogenous retinal detachment with multiple retinal breaks

作　　者：田超伟[1] 王雨生[1] 窦国睿[1] 苏晓娜[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：《中华眼底病杂志》2014年第4期357-360,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的 观察分段巩膜外垫压手术治疗多发裂孔性视网膜脱离的效果.方法 回顾性临床研究.临床确诊为多发裂孔性视网膜脱离并行分段巩膜外垫压手术治疗的17例患者17只眼纳入研究.患眼中,裂孔分布于不同象限8只眼,分布于同一象限不同纬度9只眼.存在2个裂孔3只眼,3个裂孔5只眼,＞3个裂孔 9只眼.马蹄孔4只眼,撕裂孔 1只眼,变性孔 3只眼,合并马蹄孔与变性孔 7只眼,合并马蹄孔与撕裂孔 1只眼,合并撕裂孔与变性孔 1只眼.患眼矫正视力为数指～0.8.所有患眼手术中准确定位裂孔,采用硅胶海绵或硅胶轮胎分段垫压,相互组合.手术后随访时间6个月～1年,平均随访时间9.3个月.观察患眼视网膜复位、矫正视力以及并发症发生情况.结果 17只眼中,视网膜复位15只眼,占88.2％;视网膜复位不良2只眼,占11.8％.视网膜复位的15只眼中,手术3个月后视网膜脱离复发1只眼,行玻璃体切割手术联合硅油填充后视网膜部分复位.视网膜复位不良的2只眼中,行玻璃体切割手术联合硅油填充后视网膜复位1只眼,行长效气体注入后视网膜复位1只眼.1 7只眼中,一次手术视网膜复位14只眼,占82.4％.末次随访时,16只眼视网膜复位,占94.1％.17只眼中,矫正视力提高＞2行9只眼,占52.9％;提高1～2行5只眼,占29.4％;无明显变化3只眼,占17.7％.所有患眼手术中无严重并发症发生.手术后3个月发生增生性玻璃体视网膜病变1只眼,即为视网膜脱离复发而行玻璃体切割手术治疗者.结论 分段巩膜外垫压手术治疗多发裂孔性视网膜脱离可以获得82.4％的一次手术视网膜复位率.Objective To observe the effect of segmental scleral buckling on the treatment of rhegmatogenous retinal detachment （RRD） with multiple retinal breaks.Methods This is a retrospective study.Seventeen patients （17 eyes） suffering from RRD with multiple retinal breaks were enrolled in this study.There were 8 eyes with the retinal breaks located in different quadrants and 9 eyes located in different latitudes within the same quadrant.Three were 3 eyes with 2 retinal breaks,5 eyes with 3 retinal breaks,9 eyes with more than 3 retinal breaks.The forms of retinal breaks included U-shaped break （4 eyes）,tear break （1 eye）,degenerative break （3 eyes） or U-shaped breaks combined with degenerative breaks （7 eyes）,U-shaped break.s combined with tear breaks （1 eye）,tear breaks combined with degenerative breaks （1 eye）.The best corrected vision acuity （BCVA） was count finger to 0.8.The segmental scleral buckling was performed in all patients with the reasonable combination of silicon sponges and tires.The mean followup was 9.3 months （from 6 to 12 months）.The BCVA,retinal attachment and complications were observed in the follow-up.Results Fifteen eyes were reattached without recurrent of retinal detachment （88.2％）.One eye with recurrent retinal detachment after 3 months due to proliferative vitreoretinopathy,and was partly reattached after vitrectomy combined with silicon oil tamponade.Retina remained detached in 2 eyes （11.8％）,including 1 eye reattached after combined with gas tamponade,and 1 eye with vitrectomy.Sixteen eyes were completely reattached （94.1％）,including 14 eyes were underwent only 1 operation （82.4％）.The BCVA were improved more than 2lines in 9 eyes （52.9％）,1 to2linesin5 eyes （29.4％）,and only 3 eyes （17.7％） without improvement.All patients have no serious complications during the operations.Conclusion For certain patients suffering from RRD with multiple retinal breaks,a reasonable design of segmental scleral buckling can effecti

关 键 词：视网膜脱离 外科学 巩膜扣带术 

分 类 号：R779.6[医药卫生—眼科]