硅油取出术后复发性视网膜脱离临床分析  

Clinical analysis of recurrent retinal detachment after silicone oiI removal

作　　者：白宁艳[1] 张志琴[1] 徐浩[1] 牟洁[1] 杨豪[1] 

机构地区：[1]贵州省黔西南州人民医院(遵义医学院附属第七医院)眼科,贵州省兴义市562400

出　　处：《中国实用眼科杂志》2017年第2期171-174,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨硅油取出手术后视网膜脱离复发的发生原因及影响因素。方法回顾性分析2008年1月至2016年1月在黔西南州人民医院眼科，由于各种原因导致的复杂性视网膜脱离，行玻璃体切割联合硅油填充术后完成硅油取出术的所有患者共365例（368只眼），对其术前、术中、术后眼部情况及硅油取出术后的临床资料和随访记录进行分析。结果365例（368只眼）中，视网膜再脱离2008年1月1日至2011年12月31日24例（24只眼），占患眼的17．65％，占再脱离患眼的57．14％；2012年1月1日至2016年1月1日18例（18只眼），占患眼的7．76％，占再脱离患眼的42．86％。视网膜再脱离主要发生在硅油取出术后4周内。42只眼中，周边玻璃体残留8只眼；增殖膜形成牵拉、导致视网膜再脱离9只眼；视网膜形成新的裂孔7只眼；原视网膜裂孔复发6只眼；原视网膜裂孔封闭、贴附不良9只眼；视网膜嵌塞于巩膜穿刺口，牵拉形成视网膜再脱离3只眼。结论手术者的手术技巧及手术操作熟练程度是硅油取出术后视网膜再脱离的重要影响因素，提高玻璃体视网膜手术的1期处理尤为重要。应重视术后复诊，必要时可补充激光、冷冻或联合外加压或环扎手术。硅油取出术中要仔细检查玻璃体视网膜，采取相应的处理对预防视网膜再脱离是必要的。Objective To explore the main causes and influencing factors of recurrent retinal de- tachment after silicone oil removal. Methods Retrospective analysis was performed on the clinical data of 365 patients （368 eyes） caused by retinal detachment in our department from January 2008 to January 2016. All patients underwent removal of silicone oil after vitrectomy combined with sili- cone oil tamponade. Results Retinal re-detachment occurred in 24 patients （24 eyes, 17.65%） from January 2008 to December 2011, in 18 patients （18 eyes, 7.76%） from January 2012 to January 2016. Most recurrent retinal detachment occurred in 4 week. Among these retinal re-detachment in 42 eyes, residual peripheral vitreous 8 eyes, traction of epiretinal proliferative membrane 9 eyes, new retinal hole 7 eyes, activated original retinal holes 6 eyes, non-closure of original retinal holes 9 eyes and traction of retinal incarceration in the sclera incision 3 eyes. Conclusions Operative skill and level of proficiency of operator is the main influencing factor of recurrent retinal detach- ment after silicone oil removal, it is very important to improve operative skill. It should pay atten- tion to follow-up clinic, going over the retina during silicone oil removal. Sometimes, intraocular la- ser photocoagulation or frozen or combined seleral buckling surgery is necessary.

关 键 词：视网膜脱离 硅油取出术 复发 

分 类 号：R774.12[医药卫生—眼科]