上方裂孔的泡状视网膜脱离的玻璃体切除术  

Vitrectomy in the treatment of bullous rhegmatogenous retinal detachment with retinal tears located at the upper quadrant

作　　者：汪向利[1] 张宸嘉 Wang Xiangli;Zhang Chenjia(Department of Ophthalmology,Gansu Provincial People’s Hospital,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院眼科,兰州730000

出　　处：《中华眼外伤职业眼病杂志》2019年第10期749-754,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察玻璃体切除术对上方裂孔泡状视网膜脱离的治疗效果.方法回顾性研究2014年1月至2016年12月该院上方裂孔累及黄斑区的泡状视网膜脱离采用巩膜扣带术16例(16眼)的临床资料.与2017年1月至2018年5月同样病例20例(20眼)采用玻璃体切除联合过滤空气填充术.随访3个月,比较两组手术效果.结果巩膜扣带术和玻璃体切除术两组的首次手术视网膜复位率分别为75.00%和95.00%(x^2=8.973,P=0.033).术后1周、1个月、3个月最佳矫正视力(logMAR)巩膜扣带术组成功复位的12例(12眼)为1.02±0.38、0.87±0.46和0.76±0.53;玻璃体切除组成功复位的19例(19眼)为0.43±0.32、0.28±0.25和0.16±0.26.比较两组术后视力差异均有统计学意义(t=1.094、1.186、1.273,P=0.021、0.016、0.011).玻璃体切除术组复位者术后1周黄斑区视网膜下已无积液,而巩膜扣带术组复位者术后1周、1个月、3个月黄斑区视网膜下液的发生率分别为66.7%、58.3%、58.3%,对比两组各时间点黄斑区视网膜下液发生率均有统计学意义(x2=17.072、14.316、14.316,P=0.000、0.000、0.000).结论上方裂孔的泡状视网膜脱离行玻璃体切除术可良好复位视网膜,避免黄斑区视网膜下液长久积存,早期恢复视功能.Objective To observe the efficacy of vitrectomy in the treatment of bullous rhegmatogenous retinal detachment(RRD)with retinal tears located at the upper quadrant.Methods The clinical data of 36 eyes of 36 cases with bullous RRD with retinal tears located at the upper quadrant and involving the macular in this hospital were analyzed retrospectively.There were 16 eyes of 16 patients who received scleral buckling from Jan.2014 to Dec.2016 as group A and 20 eyes of 20 patients who received 25-gauge pars plana vitrectomy combined with air tamponade from Jan.2017 to May 2018 as group B.The efficacy were compared between the two groups.The followed-up time was 3 months.Results The success rate of initial operation was 75%in group A and 95%and group B,respectively(x^2=8.973,P=O.033).BCVA(logMAR)of 12 patients with retinal reattachment in group A was 1.02±O.38,0.87±0.46 and 0.76±0.53 in 1 week,1 month and 3 months,respectively.However,BCVA of 19 patients with retinal reattachment in group B was 0.43±0.32,0.28±0.25 and 0.16±0.26,respectively.The differences in BCVA at different time after surgery were statistically significant between the two groups(t=1.094,1.186,1.273,P=0.021,0.016,0.011).The subretinal fluid(SRF)in group A at 1 week after PPV was absorbed.The incidence rate of SRF in group B were 66.7%,58.3%and 58.3%in 1 week,1 and 3 months after operation,respectively.The difference of the incidence rate of SRF was statistically significant between the two groups at each time postoperatively(x2=17.072,14.316,14.316,P=0.000,0.000,0.000).Conclusion Vitrectomy in the treatment of bullous rhegmatogenous retinal detachment with retinal tears located at the upper quadrant is beneficial for retinal reattachment and visual functional recovery,as well as avoiding the macular subretinal fluid.

关 键 词：视网膜脱离 孔源性 玻璃体切除术 扣带术 巩膜 积液 视网膜下 

分 类 号：R73[医药卫生—肿瘤]