巩膜外垫压术处置视网膜激光光凝术治疗局限性孔源性视网膜脱离效果不佳病例的临床观察  

The clinical effect of scleral buckling on localized rhegmatogenous retinal detachment with poor results after retinal laser photocoagulation

作　　者：田超伟 马文霞 武静 王雨生 Tian Chaowei;Ma Wenxia;Wu Jing;Wang Yusheng(Department of Ophthalmology,The First Affiliated Hospital Ophthalmology,Airforce Military Medical University,Eye Institute of 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,西安710032

出　　处：《眼科》2022年第5期364-368,共5页Ophthalmology in China

基　　金：陕西省重点研发计划(2017SF-227)。

摘　　要：目的观察巩膜外垫压术对激光光凝效果不佳局限性孔源性视网膜脱离(RRD)患者的临床疗效。设计回顾性病例系列。研究对象2017年1月至2021年1月空军军医大学西京医院眼科就诊的既往视网膜激光光凝术治疗局限性RRD效果不佳患者19例(19眼)。方法所有患者均行巩膜外垫压术治疗,术后补充视网膜激光光凝。随访6个月~2年,观察治疗效果。主要指标术后视网膜复位情况、视力及并发症情况。结果19眼中,垫压术后视网膜完全复位17眼(89.5%);2眼(10.5%)垫压嵴明确,但嵴上局部视网膜下存在积液,2周内视网膜下液完全吸收。2个月后2眼增生性玻璃体视网膜病变发生致视网膜脱离复发,均为首次激光后1周内行垫压术并术后2次补充激光光凝患者,行玻璃体切割硅油填充术后复位,后硅油取出稳定。末次随访时,视网膜复位19眼(100%),其中经一次巩膜外垫压稳定17眼(89.5%)。17眼(89.5%)视力无明显变化;2眼(10.5%)视力下降。结论巩膜外垫压术处置视网膜激光光凝术治疗局限性RRD效果不佳患者远期疗效肯定。局限性RRD不恰当使用激光光凝非但无效,还会有一些负面影响,视网膜激光光凝斑密集、重复激光、激光后短时间内行外垫压是导致视网膜脱离复发的潜在危险因素。(眼科,2022,31:364-368)Objective To observe the clinical effect of scleral buckling on localized rhegmatogenous retinal detachment(RRD)with poor results after retinal laser photocoagulation.Design Retrospective case series.Participants A total of 19 eyes of 19 patients with localized RRD with poor results after retinal laser photocoagulation who were treated with scleral buckling during January 2017 to January 2021 in the Ophthalmology Department of Xijing Hospital,Air Force Military Medical.Methods All patients were treated with scleral buckling and postoperative supplemental retinal laser photocoagulation.Follow-up from 6 months to 2 years to observe the therapeutic effect.Main Outcome Measures Retinal reattachment,visual acuity and other related complications after operation.Results The retina was reattached in 17 eyes(89.5%)after scleral buckling,the cristae was clear in 2 eyes(10.5%),but there was subretinal fluid under the cristae,and the subretinal fluid was completely absorbed within 2 weeks.Two months later,retinal detachment recurred due to proliferative vitreoretinopathy(PVR)in two eyes who need pars plana vitrectomy for retinal redetachment,both of them were patients who underwent scleral buckling within 1 week after the first laser and were supplemented with laser photocoagulation twice after operation.At the last follow-up,retinal reattachment was achieved in 19 eyes(100%),of which,17 eyes(89.5%)were stable after scleral buckling.Visual acuity was obviously unchanged in 17 eyes(89.5%),and decreased in 2 eyes(10.5%).Conclusion The long-term efficacy of scleral bucking in the treatment of patients with poor outcomes after retinal laser photocoagulation for localized RRD is definited.The laser treatment for localized rhegmatogenous retinal detachment was not only ineffective,but also has many negative effects.The density of the laser spot,multiple laser photocoagulations,and a short period between laser photocoagulation and scleral buckling are potential factors in the recurrence of retinal detachment.(Ophthalmol CHN,2022,31

关 键 词：视网膜脱离/外科学 巩膜外垫压 视网膜激光光凝术 

分 类 号：R779.6[医药卫生—眼科]