注气后巩膜外冷凝治疗裂孔性视网膜脱离的疗效观察  

Clinical effects of gas tamponade followed by scleral cryotherapy on rhegmatogenous retinal detachment

作　　者：佘洁婷[1] 张国明[1] 曾键[1] 陈懿[1] 刘旭阳[1] 成洪波[1] 

机构地区：[1]暨南大学附属深圳眼科医院深圳市眼科医院深圳眼科学重点实验室,518000

出　　处：《中华眼科杂志》2016年第5期354-357,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨玻璃体腔注射无菌空气后行巩膜外冷凝治疗单纯型裂孔性视网膜脱离的效果。方法回顾性研究。选取暨南大学附属深圳眼科医院2013年10月至2014年3月收治的35例（35只眼）裂孔性视网膜脱离患者，其中脱离范围累及黄斑区31例，所有均伴明显玻璃体液化。裂孔位置均位于上半部分，直径0．5～1．5PD，形态均为马蹄形。经巩膜穿刺放出视网膜下液体后，玻璃体腔注射无菌空气0．5～2．0ml，双目间接检眼镜透过气体直视下行巩膜外冷凝封闭裂孔，再行局部外垫压。结果术后第1天32例视网膜完全复位，2例残余少量视网膜下积液，均于术后1周内完全吸收，1例因术后玻璃体混浊加重，视网膜未能完全平伏而改行玻璃体切除术后复位。一次手术复位率97．1％，最终复位率100％。术后视力提高33例，发生高眼压6例，经局部降眼压药物治疗后好转。所有病例随访5～10个月视网膜脱离无复发。结论玻璃体腔注气巩膜外冷凝术治疗玻璃体液化明显的上方裂孔单纯型视网膜脱离可以提高手术成功率。Objective To evaluate the effects of intravitreal injection of sterile air followed by scleral cryotherapy on simple rhegmatogenous retinal detachment （RRD）. Methods Retrospective study. Thirty-five cases （thirty-five eyes） with RRD were collected from Oct 2013 to Mar 2014. Among them, maeular detachment was observed in 31cases, all accompanied with obvious synchesis. All retinal breaks were horseshoe shaped and holes located above 9 o＇clock to 3 o＇clock position, with size ranged from 0.5 to 1.5 PD. Subretinal fluid was drained by scleral puncture, after that 0.5-2.0 ml sterile air was injected into the vitreous cavity. Cryotherapy was done under binocular indirect ophthalmoscope followed by scleral buckling. Results Retina reattaehment was seen in 32 cases at the first day after operation. A small amount of subretinal fluid was found in 2 cases, which absorbed completely in one week after the surgery. Vitrectomy was done in 1 case because of aggravation of vitreous opacity and failure of retinal reattachment. The success rate of single operation and final operation was 97.1% and 100.0%, respectively. Visual improvement was observed in 33 cases. Ocular hypertension was seen in 6 cases and was controlled by topical antiglaueomatous eyedrops. No recurrence of RRD was found in all cases during the 5-10 months follow-up visit. Conclusion Gas tamponade followed by scleral cryotherapy can improve the success rate of operation for simple rhegmatogenous retinal detachment with obvious synchesis and retinal holes located at the upper quadrant.

关 键 词：视网膜脱离 视网膜穿孔 内填塞 玻璃体内注射 冷冻疗法 眼外科手术 

分 类 号：R779.6[医药卫生—眼科]