360度视网膜切开致黄斑转位性斜视的临床分析

目的 :针对应用 36 0°视网膜切开术治疗复杂性视网膜脱离出现黄斑转位的患者 ,分析发生视网膜旋转、黄斑转位的原因 ,并探讨旋转性斜视和复视的诊断及治疗。方法 :2例因视网膜脱离合并严重前增殖性玻璃体视网膜病变患眼 ,行松弛性 36 0°视网膜切开术后视网膜复位 ,但发生黄斑转位。观察患者手术前后的视力、双眼视功能、主客观偏斜和眼位情况、视网膜旋转度数及黄斑移位程度。结果 :病例 1随诊 2 1个月 ,术后 15个月取出硅油 ,视力从眼前光感提高到 0 0 1;病例 2随诊 3个月 ,硅油存留 ,视力从眼前光感提高到 0 0 3。 2例患者均有垂直和水平斜视 ,黄斑旋转 4 0°～ 5 0° ,黄斑移位约 1 5DD(discdi ameter,视盘直径 ) ,均有主观视物偏斜症状。结论 :36 0°视网膜切开术可能造成视网膜旋转、黄斑转位 ,出现旋转性斜视和复视。

Macular translocation after 360 degree retinotomy for complicated retinal detachment

Objective:To analyse the causes for macular translocation after 360 degree retinotomy in treatment of complicated retinal detachment, and to discuss the diagnosis and therapy for cyclotorsional strabismus and diplopia.Methods:Two cases of retinal detachment with severe proliferative vitreoretinopathy were treated with 360 degrees retinotomy during vitrectomy.The macula retine of the two cases were translocated after surgery.Visual acuity, binocular vision, degree of cyclotorsion, distance of foveal shift were investigated.Results:Retinal reattachments were obtained in the two patients .Case 1 was followed up for 21 months, vision was improved from LP to 0.01.The silicone oil in this case was removed after 15 months .Case 2 was followed up for 3 months, vision improved from LP to 0 03.Both patients developed horizontal and vertical strabismus with torsion of 40-50 degrees, macular shift about 1 5 disc diameter, and both patients complained of image tilt.Conclusion:360 degree retinotomy is a valuable technique to reattach the retina with advanced proliferative vitreoretinopathy, but the retina may be rotated and the macula translocated which cause significant ocular torsion and strabismus.