巩膜外加压术术中冷凝与术后光凝治疗孔源性视网膜脱离的效果比较  

Comparison on the efficacies between scleral buckling combined with intraoperative cryotherapy and postoperative photocoagulation in the treatment of rhegmatogenous retinal detachment

作　　者：侯敏 韩少平 李红霞 樊冬生 Hou Min;Han Shaoping;Li Hongxia;Fan Dongsheng(Department of Ophthalmology,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471009,China)

机构地区：[1]郑州大学附属洛阳中心医院眼科,洛阳471009

出　　处：《中华眼外伤职业眼病杂志》2022年第5期338-343,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学科技攻关计划(LHGJ20191230)。

摘　　要：目的比较巩膜外加压术术中冷凝与术后光凝治疗孔源性视网膜脱离(RRD)的效果。方法前瞻性随机对照研究。分析郑州大学附属洛阳中心医院2018年1月至2021年7月58例(58只眼)接受巩膜外加压术的RRD的临床资料。患者按随机数字表法分为两组:冷凝组29例,接受术中冷凝;光凝组29例,接受术后视网膜光凝。术后随访3个月,比较两组手术耗时、术后痛疼分级、术后眼睑水肿程度、视网膜复位率、视力及并发症。结果光凝组手术耗时较冷凝组短(t=-2.74,P=0.008);光凝组术后疼痛及眼睑水肿程度较冷凝组低(χ^(2)=7.13,8.03;P=0.028,0.018);术后两组患者视力(BCVA)均逐渐提高(F_(时间)=23.99,P_(时间)<0.001),但术后两组之间视力差异无统计学意义(F=0.51,P=0.476)。术后1周,光凝组视力较冷凝组提高更快;两组视网膜复位率及并发症发生率差异无统计学意义(χ^(2)=0.35,1.07;P=0.553,0.300)。结论巩膜外加压术联合术中冷凝或术后光凝治疗RRD的效果相似,但术后激光光凝可简化手术步骤、缩短手术耗时、减轻术后疼痛及眼睑水肿反应,术后早期视力提高明显。Objective To compare the efficacies between scleral buckling combined with intraoperative cryotherapy and postoperative photocoagulation in the treatment of rhegmatogenous retinal detachment(RRD).Methods This was a prospective randomized study.The clicinal data of 58 eyes of 58 patients with RRD who underwent scleral buckling from Jan.2018 to Jul.2021 in Luoyang Central Hospital Affiliated to Zhengzhou University.The patients were divided into two groups based on the random number table methods.The cryotherapy group with 29 patients accepted intraoperative cryotherapy,while the photocoagulation group with 29 patients received retinal photocoagulation after surgery.All patients were followed up for 3 months after operation.The operation time,postoperative pain grade,eyelid edema degree,retinal reattachment rate,visual acuity and complications were compared between the two groups.Results The operation time of the photocoagulation group was shorter than that of the cryotherapy group(t=-2.74,P=0.008),while the postoperative pain grade and eyelid edema degree significantly reduced compared with that of the cryotherapy group(χ^(2)=7.13,8.03;P=0.028,0.018).The postoperative BCVA gradually increased in both groups(F_(time point)=23.99,P_(time point)<0.001),but there was no significant difference in the BCVA between the two groups(F=0.51,P=0.476).At 1 week postoperatively,the BCVA of the laser photocoagulation group improved faster than that of cryotherapy group.There was no significant difference in retinal reattachment rate and complication rate between the two groups(χ^(2)=0.35,1.07;P=0.553,0.300).Conclusion Scleral buckling combined with intraoperative cryotherapy or postoperative laser photocoagulation have similar efficacy and safety,but postoperative laser photocoagulation shortens operation time,simplifies steps,reduces postoperative pain and eyelid edema,and achieves better visual acuity postoperatively in early stage.

关 键 词：视网膜脱离 巩膜扣带术 视网膜穿孔 冷冻疗法 激光凝固术 

分 类 号：R779.6[医药卫生—眼科]