伴严重增殖性玻璃体视网膜病变视网膜脱离的玻璃体手术及失败原因探讨

本文报导采用现代玻璃体手术结合巩膜扣带、空气或硅油填塞治疗81例伴严重增殖性玻璃体视网膜病变(PVR)视网膜脱离的手术效果.经过6～28个月(平均14个月)的随访,视网膜完全平伏者54例,成功率66.7%,对极严重的PVR D(?)(闭斗状脱离)也取得50%的成功率.硅油填塞初步应用于极严重病例尤其是巨大裂孔的治疗,取得明显的效果.本文病例术后视力提高者50例,不变19例,下降12例,术后视力在0.05以上者共34例.认为玻璃体手术结合其它技术是伴严重PVR手术治疗的有效方法,提出进一步提高PVR治疗成功率的方法:彻底清除增殖膜及寻找一种有效抑制膜增殖而对眼内其它组织无毒性的药物。指出旧的PVR分级法存在的不足,推荐用于硅油研究的PVR新的分级法.

Vitreous surgery for retinal detachment with severe proliferative vitreoretinopathy and probe of failed cause]

Eighty-one cases (81 eyes) of retinal detachment with severe proliferative vitreoretinopathy were treated using vitrectomy, scleral buckling and air or silicone oil tamponade technique. After a follow-up period of 6-28 months, 54 cases obtained anatomic retinal attachment (66.7%). For the serious cases of PVR D3, we also gained a success rate of 50%. Vision improved in 50 cases, whereas 34 cases got a vision better than 0.05. For the failed cases, cause that prevent the retina from attachment was probed. We think that vitrectomy is an essential and important procedure for retinal detachment with severe PVR, membrane peeling is the key of success and prevention of reproliferation can avoid recurrent retinal detachment and further raise the success rate of treatment. A new classification is recommended in this article.