有晶体眼网脱术后硅油早期进入前房的临床特点及处理  

Clinical Characteristics and Treatment of Silicone Oil Entry into the Anterior Chamber Early Following Retinal Detachment Surgery with Lens

作　　者：张营春 高愫 张琦 Zhang Yingchun(Fuzhou Eye Hospital,Fuzhou Fujian 350007)

机构地区：[1]福州眼科医院,福建福州350007

出　　处：《黑龙江医药》2024年第6期1306-1310,共5页Heilongjiang Medicine journal

基　　金：三明市引导性科技项目(项目编号:2022-S-6),课题名称:孔源性视网膜脱离并发PVR患者视网膜下液中生长因子测定的临床意义。

摘　　要：目的:分析有晶体眼原发性孔源性视网膜脱离术后硅油早期进入前房的临床特点、处理方案。方法:收集并回顾性分析我院2022年6月至2024年1月诊治的有晶体眼原发性孔源性视网膜脱离患者126例(126眼)的一般资料及相关眼科检查结果,所有患者均行单纯玻璃体切除联合硅油填充手术,术后1周内硅油进入前房定义为硅油早期进入前房。根据是否发生早期硅油进入前房,分为观察组(硅油早期进入前房)和对照组(硅油未进入前房),比较两组患者一般资料、最佳矫正视力、屈光度、术前术后眼压、PVR分级、裂孔大小、术前是否合并脉络膜脱离等相关参数,分析此类患者发生硅油早期进入前房的危险因素。结果:126眼中有17眼发生硅油早期进入前房,有晶体眼原发性孔源性视网膜脱离术后硅油早期进入前房的比例为13.49%(17/126)。硅油早期进入前房与屈光度≥-6.0D高度近视、玻璃体视网膜增殖严重(PVR≥C2)、巨大裂孔性视网膜脱离、术前合并脉络膜脱离有关(P<0.05)。观察组中有12眼发生高眼压,其中5眼保守治疗眼压控制不佳,行下方虹膜周边切除联合面向下体位后硅油回退至玻璃体腔,眼压逐渐控制。结论:屈光度≥-6.0D高度近视、玻璃体视网膜增殖严重(PVR≥C2)、巨大裂孔性视网膜脱离、术前合并脉络膜脱离是有晶体眼原发性孔源性视网膜脱离行玻璃体切除联合硅油填充术后发生硅油早期进入前房的危险因素。对于硅油进入前房、高眼压保守治疗眼压控制不佳的患者,及时行下方虹膜周边切除能够有效促使硅油回退至玻璃体腔,控制眼压,减少对视神经、角膜内皮细胞的损伤。Objective:To analyze the clinical characteristics and treatment of silicone oil entry into the anterior chamber early following primary rhegmatogenous retinal detachment surgery with lens.Methods:The general data and related ophthalmic examination results of 126 patients(126 eyes)with primary rhegmatogenous retinal detachment with lens,treated in our hospital from June 2022 to January 2024,were collected and retrospectively analyzed.All patients underwent simple vitrectomy combined with silicone oil tamponade.Silicone oil entry into the anterior chamber within one week after surgery was defined as silicone oil early entry.Based on whether silicone oil entered the anterior chamber early or not,the patients were divided into two groups:observation group and control group.General data,best corrected visual acuity,diopter,preoperative and postoperative intraocular pressure,proliferative vitreoretinopathy classification,hole size,preoperative choroidal detachment or not,and other related parameters were compared between the two groups.Results:Early entry of silicone oil into the anterior chamber occurred in 17 out of 126 eyes following primary rhegmatogenous retinal detachment surgery.The proportion of silicone oil entry into the anterior chamber early in eyes with lens was 13.49%(17/126).Early entry of silicone oil into the anterior chamber was found to be associated with high myopia(≥-6.0D),severe proliferative vitreoretinopathy(PVR≥C2),rhegmatogenous retinal detachment-related giant retinal tears and preoperative choroidal detachment(P<0.05).In the observation group,12 eyes developed intraocular hypertension,among which 5 eyes had inadequate control after conservative treatment.These eyes underwent inferior peripheral iridectomy combined with a prone position to facilitate the silicone oil go back to the vitreous cavity,resulted in gradual control of intraocular pressure.Conclusion:High myopia,PVR≥C2,rhegmatogenous retinal detachment-related giant retinal tears and preoperative choroidal detachment are risk f

关 键 词：孔源性视网膜脱离 硅油 前房 高眼压 下方虹膜周边切除 

分 类 号：R774.12[医药卫生—眼科]