显微镜下三联手术治疗合并白内障的孔源性视网膜脱离的效果  

Clinical Effect of Triple Surgery under a Microscope for Rhegmatogenous Retinal Detachment with Cataract

作　　者：李健[1] 陈海英[1] 黄正如[1] Jian Li;Haiying Chen;Zhengru Huang(Department of Ophthalmology,Changshu No.2 Hospital,Suzhou 215500,China)

机构地区：[1]江苏省常熟市第二人民医院眼科,苏州215500

出　　处：《中华眼视光学与视觉科学杂志》2021年第9期694-699,共6页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:分析显微镜下白内障超声乳化吸除、人工晶状体植入和巩膜外加压三联手术治疗合并白内障的孔源性视网膜脱离(RRD)的疗效。方法:回顾性研究。选择2010年1月至2017年12月在常熟市第二人民医院眼科住院的合并白内障的RRD患者17例(17眼)。患者均在显微镜下行白内障超声乳化吸除、人工晶状体植入和巩膜外加压三联手术,术后随访观察视网膜的解剖复位、视力、并发症等情况,随访时间为(15.2±3.6)个月。手术前后最佳矫正视力(BCVA)及预设术后屈光度与术后实测屈光度的比较行Wilcoxon符号秩和检验。结果:所有术眼的视网膜裂孔在显微镜下清晰可见,视网膜压嵴位置良好,裂孔封闭,视网膜均解剖复位,视力较术前明显提高(Z=3.825,P<0.001)。预设屈光度与术后实测屈光度差异无统计学意义(Z=1.519,P=0.13)。术后I到II级角膜内皮水肿2眼,一过性高眼压2眼,轻中度前房纤维蛋白渗出2眼,不同程度后囊膜混浊4眼,黄斑前膜1眼,未出现视网膜下液引流和玻璃体腔感染、眼底出血等并发症。结论:显微镜下白内障超声乳化吸除、人工晶状体植入和巩膜外加压三联手术能安全有效治疗合并白内障的RRD。Objective:To evaluate the efficiency of phacoemulsification combined with intraocular lens implantation and scleral buckling for rhegmatogenous retinal detachment(RRD)accompanied by cataract.Methods:This retrospective study was performed from January 2010 to December 2017 in the Department of Ophthalmology,Changshu No.2 Hospital.Seventeen patients(17 eyes)with RRD accompanied by cataract underwent a triple procedure involving phacoemulsification,intraocular lens implantation and scleral buckling using a surgical microscope.The anatomical success rate,best corrected visual acuity,and complications were observed.The follow-up time was 15.2±3.6 months.The best corrected visual acuity(BCVA)before and after the operation and pre-set postoperative refractive error(RE)and the measured postoperative RE were tested by a Wilcoxon signed rank test.Results:A clear intraoperative view of retinal breaks was obtained.The retinas were reattached anatomically in all cases while the retinal breaks were perfectly buckled.Postoperative BCVA increased significantly(Z=3.825,P<0.001).There was no statistically significant difference between the preset RE and the postoperative measured RE(Z=1.519,P=0.13).There was 2 eyes with grade I to II corneal endothelium edema,2 eyes with transient high intraocular pressure,2 eyes with mild to moderate anterior chamber fibrin exudation,4 eyes with posterior capsular opacity,and 1 eye with macular epiretinal membrane.There were no complications such as subretinal fluid drainage,vitreous cavity infection or fundus hemorrhage.Conclusions:A triple procedure of phacoemulsification,intraocular lens implantation and scleral buckling using a surgical microscope is a practical and safe approach for RRD accompanied by cataract.

关 键 词：孔源性视网膜脱离 白内障 超声乳化吸除术 巩膜外加压术 手术显微镜 

分 类 号：R779.6[医药卫生—眼科]