充分硅油填充术治疗复发性视网膜脱离的有效性和安全性研究  

Adequate silicone oil tamponade technique for recurrent retinal detachment:An effectiveness and safety study

作　　者：王一帆[1] 黄梓敬 柳俊涛 黄定国[1] 郑德志[1] 林培敏[1] 谢海霞 李美玲[1] 陈伟奇[1] Wang Yifan;Huang Zijing;Liu Juntao;Huang Dingguo;Zheng Dezhi;Lin Peimin;Xie Haixia;Li Meiling;Chen Weiqi(STU-CUHK Joint Shantou International Eye Center,Shantou 515041,China)

机构地区：[1]汕头大学·香港中文大学联合汕头国际眼科中心,汕头515041

出　　处：《临床眼科杂志》2024年第5期385-392,共8页Journal of Clinical Ophthalmology

基　　金：汕头市医疗卫生科技计划项目[汕府科(2021)68-76]。

摘　　要：目的探讨应用前后段联合手术,后囊切开联合下方周边虹膜造孔、充分硅油填充治疗复发性视网膜脱离的解剖复位率、视力恢复、手术相关并发症情况等临床疗效。方法前瞻性系列病例研究。研究纳入2018年6月至2022年6月,在汕头国际眼科中心诊治的,既往有明确的孔源性视网膜脱离病史并曾行1次或多次视网膜脱离复位术,术后视网膜仍有脱离的患者25例(25只眼)。其中男性14例,女性11例,平均年龄(52.92±13.94)岁,既往平均行(1.44±0.71)次手术(范围1~3次)。本次术前增生性玻璃体视网膜病变(PVR)C_(1)级3只眼,C_(2)级9只眼,C_(3)级11只眼,D_(1)级2只眼;上方裂孔5只眼,下方裂孔18只眼,上下方均有裂孔2只眼;合并脉络膜脱离2只眼。应用晶状体后囊膜切开、下方周边虹膜造孔,充分硅油填充治疗。收集并分析术前、术后3个月、已取油患者取油后2个月及末次随访的最佳矫正视力、眼压、视网膜情况、眼内硅油状态、手术并发症及其处理等。结果所有患者出院时视网膜平伏,硅油完全退回玻璃体腔。术后3个月,所有患者视网膜平伏,平均眼压(14.24±6.28)mmHg。平均随访时长(20.64±12.20)个月,期间所有研究眼玻璃体腔裂隙灯前置镜下及欧堡眼底照相均未观察到油水界面,提示硅油充填相对充分。其中17只眼已取出眼内硅油,平均硅油填充时间(7.26±2.02)个月,在取出眼内硅油前行角膜内皮镜检查,角膜内皮丢失率18.57%。8只眼未取出眼内硅油,平均随访时长(24.38±12.07)个月,其中高度近视黄斑萎缩明显、视力较差3只眼;广泛视网膜及脉络膜疤痕、眼压≤8mmHg3只眼;拒绝再次手术取油2只眼,至末次随访,17只眼已取出眼内硅油均保持视网膜完全贴附,8只眼未取出硅油均保持视网膜复位,未发现硅油乳化迹象。末次随访最佳矫正视力logMAR(1.21±0.60)较术前logMAR(1.66±0.66)提高,差异有统计学意义(P<0.05)�Objective To assess the surgical outcomes of phaco-vitrectomy following posterior capsulotomy,inferior peripheral iridotomy,and adequate silicone oil tamponade in a series of patients with recurrent retinal detachment,including the anatomical surgery successful rate,visual function,and surgical complications.Methods In this prospective case series study,25 eyes of 25 patients diagnosed with recurrent retinal detachment between June 2018 and June 2022 in Joint Shantou International Eye Center were included.All patients had a history of one or more rhegmatogenous retinal detachment surgeries.Fourteen patients were male and 11 patients were female.The mean age was(52.92±13.94)years old with an average of 1.44±0.71 times of retinal detachment surgery.The proliferative vitreoretinopathy(PVR)grade at first presentation was C_(1)(n=3),C_(2)(n=9),C_(3)(n=11),and D_(1)(n=2).Five eyes showed superior retinal breaks,18 eyes showed inferior breaks,and 2 eyes presented with both.Two patients presented with combined choroidal detachment.Adequate silicone oil tamponade followed by posterior capsulotomy and inferior peripheral iridotomy was performed.Preoperative and follow-up data including best corrected visual acuity,intraocular pressure,the retina and silicone oil status,and surgical complications and management,were collected and analyzed.Results On the day of discharge,all eyes demonstrated an attached retina and complete migration of the anterior chamber silicone oil into the vitreous cavity.At the 3-month followup,all retinas were attached with a mean intraocular pressure of(14.24±6.28)mmHg.The mean follow-up time was(20.64±12.20)months,and all the eyes presented relatively adequate silicone oil tamponade with no signs of oil-fluid interface in the vitreous cavity.Seventeen eyes had the silicone oil removal at(7.26±2.02)months after the primary procedures.18.57%of corneal endothelial loss was found at the time of silicone oil removal in these patients.Eight eyes,with a follow-up period of(24.38±12.07)months,did not

关 键 词：复发性视网膜脱离 硅油充分填充 后囊切开 下方周边虹膜造孔 

分 类 号：R779.6[医药卫生—眼科]