孔源性视网膜脱离巩膜扣带与玻璃体切除术效果比较  

Comparison on the effects between sclerai buckling surgery and vitrectomy for rhegmatogenous retinal detachment

作　　者：宋莉[1] 沙翔垠[1] 杨瑞明[1] 郑瑜[1] 吴兴萍[1] 邹湖涌[1] 文晔[1] 

机构地区：[1]广州医科大学附属第二医院眼科,510260

出　　处：《中华眼外伤职业眼病杂志》2015年第12期886-889,共4页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：广州市中医药和中西医结合科技项目（20142A010016）

摘　　要：目的比较巩膜扣带术与玻璃体切除术治疗是及黄斑的孔源性视网膜脱离（RRD）的效果。方法累及黄斑的伴轻中度增生性玻璃体视网膜病变（PVR）的RRD45例（45只眼）按随机数字表法分为两组：A组，27例（27只眼）行玻璃体切除术，B组，18例（18只眼）行巩膜扣带术。观察术后视网膜复位情况、视力、眼压、并发症及视网膜下液吸收情况。结果两组视网膜复位率及视力提高率差异均无统计学意义（Fisher确切概率法，P=0．155；χ2=0．417，P=0．519）；术后白内障的发生率，A组明显高于B组，差异有统计学意义（χ2=5．561，P=0．018）；两组一过性高眼压、视网膜前膜及视物变形，差异均无统计学意义（χ2=1．831，0．011，0．234；P=0．176，0．915，0．628），两组在术后1个月仍存在视网膜下液者，B组多于A组，差异有统计学意义（χ2=15．162，P=0．000）。结论对于累及黄斑的伴轻中度PVR的RRD，巩膜扣带术与玻璃体切除术都能取得良好的疗效，虽然微创技术的发展使玻璃体切除术有成为治疗RRD主要术式的趋势，但巩膜扣带术仍然不失为有效的手术方式之一。Objective To compare the efficacy of scleral buckling surgery and vitrectomy for macula-off rhegmatogenous retinal detachment （ RRD ）. Methods Forty-five eyes of 45 macula-off RRD patients with mild-to-moderate proliferative vitreoretinopathy （ PVR ） were randomly divided into two groups according to the random number chart. Twenty-seven eyes of 27 patients in group A were treated with vitrectomy and 18 eyes of 18 patients in group B were treated with scleral buckling surgery. The condition of retinal reattachment, vision, intraocular pressure （ IOP）, complications and subretinal fluids absorption condition were observed. Results There were not statistically significant differences in anatomic success rate and visual acuity improvement between the two groups （ Fisher＇ s exact probability test, P = 0. 155;X2 = 0. 417, P = 0.519）. The incidence of postoperative complicated cataract of group A was higher than that of group B and the statistically significant difference was found （X2 = 5. 561, P = 0.018）. There were not statistically significant differences in the incidence of transient high IOP, epiretinal membrane or metamorphopsia （X2 = 1. 831, 0. 011, 0. 234; P = 0. 176, 0. 915, 0. 628）. The incidence of subretinal fluids one month after the surgery of group B was higher than that of group A and the difference was statistically significant （X2 = 15. 162, P = 0. 000 ）. Conclusion Both seleral buckling surgery and vitrectomy are effective methods for macula-off RRD patients with mild-to-moderate PVR. Though the trend is toward PPV benefited from transconjunctival sutureless vitrectomy （TSV）, the scleral buckling surgery can still be considered as an effective treatment choice.

关 键 词：视网膜脱离 孔源性 玻璃体切除术 巩膜扣带术 

分 类 号：R779.6[医药卫生—眼科]