巩膜扣带手术治疗伴视网膜下增生的孔源性视网膜脱离疗效观察  

Efficacy of scleral buckling for rhegmatogenous retinal detachment with subretinal proliferation

作　　者：朱丽 李红 胡城 黄志坚 晏颖 丁琴 陈晓 Zhu Li;Li Hong;Hu Cheng;Huang Zhijian;Yan Ying;Ding Qin;Chen Xiao(Department of Ophthalmology,Central Theater Command General Hospital,Fundus Laser Clinical Medical Research Center,Wuhan 430070,China;Department of Ophthalmology,The 940th Hospital of Joint Logistics Support Force of Chinese,Lanzhou 730000,China)

机构地区：[1]解放军中部战区总医院眼科眼底激光临床医学研究中心,武汉430070 [2]联勤保障部队第九四〇医院眼科,兰州730000

出　　处：《中华眼底病杂志》2023年第12期974-978,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察巩膜扣带手术(SB)治疗陈旧性孔源性视网膜脱离(RRD)伴视网膜下增生(SRP)的疗效。方法回顾性病例研究。2016年1月至2018年12月于解放军中部战区总医院眼科行SB治疗的陈旧性RRD伴SRP患者31例35只眼纳入研究。其中,男性18例20只眼,女性13例15只眼;年龄(26.5±8.7)岁;病程(12.6±10.3)个月。采用国际标准视力表行最佳矫正视力(BCVA)检查,记录时换算为最小分辨角对数(logMAR)视力。患眼logMAR BCVA 1.02±0.49。视网膜脱离范围≤2、>2~<3、≥3个象限分别为10(28.6%,10/35)、20(57.1%,20/35)、5(14.3%,5/35)只眼。所有患眼均行SB治疗。其中,行局部巩膜外垫压手术22只眼(63.0%,22/35),巩膜外垫压联合环扎手术11只眼(31.4%,11/35),单纯巩膜环扎手术2只眼(5.7%,2/35)。手术中行巩膜外放液33只眼(94.3%,33/35)。手术后平均随访时间18.2个月。采用手术前相同设备和方法行相关检查,观察BCVA、视网膜复位等情况。手术前后logMAR BCVA比较采用配对样本t检验。结果末次随访时,35只眼中,视网膜复位32只眼(91.4%,32/35);视网膜未复位3只眼(8.6%,3/35)。患眼logMAR BCVA 0.67±0.29(数指~1.0)。手术前后logMAR BCVA比较,差异有统计学意义(t=5.133,P=0.036)。35只眼中,视力提高、稳定、下降分别为19(54.3%,19/35)、13(37.1%,13/35)、3(8.6%,3/35)只眼。手术后10个月硅胶带暴露合并感染1只眼,拆除硅胶带,感染消退,视网膜在位。手术中及手术后无眼内出血、玻璃体视网膜嵌塞、眼内炎等并发症。结论SB治疗伴有SRP的RRD可以获得良好的视网膜复位,并可一定程度改善视力。Objective To observe the effect of scleral buckling surgery(SB)in the treatment of rhegmatogenous retinal detachment(RRD)with subretinal hyperplasia(SRP).Methods A retrospective case study.From January 2016 to December 2018,31 patients with old RRD with SRP who were treated with SB in Department of Ophthalmology,Central Theater Command General Hospital were included in the study.There were 18 males with 20 eyes and 13 females with 15 eyes.Age was(26.5±8.7)years.The course of disease was(12.6±10.3)months.The best corrected visual acuity(BCVA)test was performed using the international standard visual acuity chart,which was converted to logarithm of the minimum angle of resolution(logMAR)visual acuity at the time of recording.Retinal detachment ranges≤2,>2-<3,≥3 quadrants were 10(28.6%,10/35),20(57.1%,20/35),and 5(14.3%,5/35)eyes,respectively.All affected eyes were treated with SB.Among them,22 eyes(63.0%,22/35)underwent local Scleral buckling,11 eyes(31.4%,11/35)underwent combined encircling buckle,and 2 eyes(5.7%,2/35)underwent encircling buckle alone.Subretinal fluid drainage was performed in 33 eyes(94.3%,33/35).The mean follow-up time was 18.2 months.Relevant examinations were performed with the same equipment and methods before operation to observe BCVA and retinal reattachment.Paired sample t test was used to compare logMAR BCVA before and after operation.Results At the last follow-up,retinal reattachment occurred in 32 eyes(91.4%,32/35)of 35 eyes.The retina did not reset in 3 eyes(8.6%,3/35).logMAR BCVA of affected eye was 0.67±0.29(finger counting-1.0).The difference of logMAR BCVA before and after operation was statistically significant(t=5.133,P=0.036).In 35 eyes,visual acuity improved,stabilized and decreased in 19(54.3%,19/35),13(37.1%,13/35)and 3(8.6%,3/35)eyes,respectively.Ten months after surgery,the silicone tape was exposed and infected 1 eye.After the silicone tape was removed,the infection subsided and the retina was in place.There were no intraocular hemorrhage,vitreoretinal impaction,end

关 键 词：巩膜扣带手术 孔源性视网膜脱离 视网膜下增生 

分 类 号：R779.6[医药卫生—眼科]