预防性视网膜激光光凝对原下方裂孔硅油取出术后视网膜再脱离的影响  

The effect of prophylactic laser retinopexy during primary vitrectomy on inferior rhegmatogeuous retinal redetachment after silicone oil removal

作　　者：施彦[1] 俞存[1] 林呈飞[1] 林鹏耀[1] 

机构地区：[1]宁波市第一医院眼科中心,浙江315010

出　　处：《中国实用眼科杂志》2015年第11期1257-1260,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨原下方裂孔性视网膜脱离硅油取出术前行预防性下方周边部180°预防性视网膜激光光凝及预防性周边部360°视网膜激光光凝对术后视网膜再脱离的影响。方法对2005年1月至2012年4月在宁波市第一医院眼科就诊的133例原为下方裂孔视网膜脱离行硅油取出术的患者资料进行回顾性分析。180°激光光凝组（A组）42例于硅油取出手术前行预防性下方周边部180。视网膜激光光凝；360°激光光凝组（B组）46例于硅油取出手术前行预防性周边部360。视网膜激光光凝：对照组（C组）45例硅油取出手术前未行预防性视网膜激光光凝。结果硅油眼内填充时间为8～56周，平均硅油填充时间（16．09±7．29）周。硅油取出术后15例患者发生视网膜再脱离，其中A组2例，占该组患者的4．76％（2／42）OB组3例，占该组患者的6．52％（3／46）。C组10例，占该组患者的22．22％（10／45）。A组与C组、B组与C组视网膜再脱离发生率比较，差异有统计学意义（P〈0．05）。A组与B组视网膜再脱离发生率比较，差异无统计学意义（P〉0．05）。15例视网膜再脱离患者中，主要为遗漏裂孔和原裂孔封闭不良、增生性玻璃体视网膜病变进展。8例为被硅油暂时性封闭的遗漏小裂孔或激光光凝作用不足导致的原裂孔重新开放，7例为增生性玻璃体视网膜病变新裂孔形成。结论预防性周边部视网膜激光光凝与硅油取出手术后视网膜降低再脱离发生率有关。不同视网膜激光光凝方式对下方裂孔性视网膜脱离硅油取出术后视网膜再脱离发生率无明显关系。[Abstract] Objective To investigate the effect of prophylactic 180° peripheral and 360° laser ret- inapexy on inferior rhegmatogeuous retinal redetachment after silicone oil removal. Methods The da- ta of 133 vitreoretinal patients after silicone oil removal were retrospectively analyzed. Forty-two pa- tients in 180° laser retinapexy group （Group A） were taken prophylactic 180° peripheral retinopexy before silicone oil removal; 46 patients in 360° laser retinapexy group （Group B） were taken 360° peripheral retinopexy before silicone oil removal while 45 patients in control group （Group C） weren＇t. Results The duration of silicone oil tamponade was 8-56 weeks, averaged （16.09±7.29） weeks. Fifteen cases of retinal redetachment were recorded after silicone oil removal, including 2 cas- es in Group A （4.76%）, 3 in Group B （6.52%） and 10 in Group C （22.22%）. The difference be- tween Group A and Group C was statistically significant （P 〈0.05）and the same with Group B and Group C. There was no statistical difference between Group A and Group B （P 〉0.05）. Among these 15 patients with retinal redetachment, the main causes were omission of small retinal breaks or reopening of original hole and the development of proliferative vitreoretinopathy （PVR）. Eight cas- es of redetachment resulted from the omission of small retinal breaks closed by silicone oil temporar-ily or the reopening of primary retinal breaks because of insufficient photocoagulation during the op- eration, 7 cases resulted from the formation of new breaks from the PVR. Conclusions Prophylac- tic laser retinopexy is associated with a decrease of the incidence of retinal redetachment after re- moval of silicone oil. There is no significant correlation by different prophylactic laser retinopexy on inferior rhegmatogeuous retinal redetachment after silicone oil removal.

关 键 词：视网膜脱离 激光凝固术 硅油类 

分 类 号：R774.12[医药卫生—眼科]