玻璃体切除术和巩膜扣带术治疗非后极部裂孔人工晶状体眼视网膜脱离  

Vitrectomy and scleral buckling in the treatment of non-posterior hole retinal detachment in pseudophakic eyes

作　　者：田超伟 王雨生 马文霞 窦国睿 Tian Chaowei;Wang Yusheng;Ma Wenxia;Dou Guorui(Department of Ophthalmology,the First Affiliated Hospital Ophthalmology,Air force Military Medical University,Eye Institute of Chinese PLA,Xi’an 710032,China)

机构地区：[1]空军军医大学西京医院眼科全军眼科研究所

出　　处：《临床眼科杂志》2020年第1期25-29,共5页Journal of Clinical Ophthalmology

基　　金：陕西省一般项目-社会发展领域(基金编号:2017SF-227)

摘　　要：目的对比观察玻璃体切除术(PPV)和巩膜扣带术(SB)对非后极部裂孔引起的人工晶状体眼视网膜脱离的临床疗效。方法回顾性临床研究。人工晶状体眼视网膜脱离(RRD)32例(32只眼)。按手术方式不同分为玻璃体切除术组(PPV组,A组)和巩膜扣带术组(SB组,B组),均为16例(16只眼)。年龄32~67岁。手术前矫正视力为光感至1.0。视网膜脱离为增生性玻璃体视网膜病变(PVR)C2级以下,排除后极部视网膜裂孔(包括黄斑裂孔)及巨大裂孔。PPV者采用闭合式23G微创玻璃体切除手术并注入硅油。SB者采用硅胶海绵或硅胶轮胎垫压(或联合环扎术)。手术后随访3~6个月,平均随访时间为4.1个月。观察两组患眼疗效。结果PPV组患眼第1次手术后视网膜复位率为93.8%(15/16),最终视网膜复位率为93.8%(15/16),去除硅油填充眼后视网膜复位率为50.0%(8/16)。SB组患眼第1次手术后视网膜复位率为75.0%(12/16),最终视网膜复位率为87.5%(14/16),去除硅油填充眼后视网膜复位率为87.5%(14/16)。两组视网膜解剖复位率比较,差异无统计学意义(P>0.05)。最终PPV组视力改善率优于SB组,两组差异有统计学意义(P<0.05)。结论非后极部裂孔引起的人工晶状体眼视网膜脱离需依据视网膜裂孔的位置、形态及患者的特点综合考虑,制定个体化治疗方案。玻璃体切除术及巩膜扣带术可以取得一定疗效。Objective To assess the effect of pars plana vitrectomy(PPV)and scleral buckling(SB)in the treatment of non-posterior pole retinal detachment in pseudophakic eyes.Methods This study was a retrospective clinical study,and 32 eyes from 32 pseudophakic patients with retinal detachment were included in this study.According to different surgical methods,the patients were divided into the vitrectomy group(PPV group,group A,16 eyes)and scleral buckling group(SB group,group B,16 eyes).The age of patients range from 32 to 67 years.The preoperative best-corrected visual acuity ranged from light perception to 1.0.All patients had retinal detachment of PVR grade C2 or lower,and those with posterior pole retinal detachment(including macular holes)and giant holes were excluded.The patients in group A were treated with 23 G vitrectomy and silicone oil injection,while patients in group B were treated with scleral buckling.The patients in both group were followed up for 3 to 6 months(mean duration of 4.1 months)after the surgery to assess the treatment efficacy.Results At the end of follow-up,the retinal reattachment rate after the first operation was 93.8%(15/16)in the PPV group and 75.0%(12/16)in the SB group without statistically significant difference(P>0.05).The rate of complete retinal reattachment in the PPV group was 93.8%(15/16)and 87.5%(14/16)in the SB group without statistically significant difference(PP>0.05).The retinal reattachment rate after removal of silicone oil was 50.0%(8/16)in the PPV group and 87.5%(14/16)in the SB group without statistically significant difference(P>0.05).The rate of visual acuity improvement was significantly better in the PPV group(P<0.05).Conclusions Individualized treatment options should be established for the treatment of non-posterior pole retinal detachment in pseudophakic eyes,and surgical considerations should include patient characteristics as well as the location and shape of the retinal hole.PPV and scleral buckling can achieve good clinical outcomes.

关 键 词：人工晶状体眼 孔源性视网膜脱离 玻璃体切除术 巩膜扣带术 

分 类 号：R779.6[医药卫生—眼科]