视网膜切开与切除术在复杂性视网膜脱离手术中的应用

目的探讨视网膜切开与切除术在复杂性视网膜脱离手术中的临床应用。方法对１９９７年９月至１９９８年１２月间行视网膜切开与切除的２４例复杂性视网膜脱离患者作回顾性分析。其中巨大裂孔性网脱１５例，外伤牵引性视网膜脱离２例，增殖性血管性视网膜病变２例，复发性视网膜脱离３例，前部ＰＶＲ２例。手术联合玻璃体切除联合巩膜扣带技术，三通道睫状体平部晶体／玻璃体切除、膜剥离、过氟化碳液体使用、眼内激光、硅油－过氟化碳液体交换填充硅油或气体－过氟化碳液体交换填充Ｃ２Ｆ６气体。其中采用视网膜切开１０例，视网膜切除１０例，视网膜切开联合切除４例。结果２４例患者近期（出院时）观察视网膜解剖复位２２例，有效率为９１．７％，１９例视力不同程度的改善。１５例巨大裂孔僵硬边缘切除或裂孔两边松驰性视网膜切开，解剖复位１４例，视力改善。术后随访１９例，时间为３～１４月（平均６月），视网膜复位１８例，占９４．７％，视力≥０．０５者９例，占５０％，眼球萎缩及低眼压１例。结论视网膜切开与切除术提高了复杂性视网膜脱离手术的成功率。

Clinical application of retinotomy and retinectomy for complicated retinal detachment

Objective To observe the effects of retinotomy and retinectomy in complicated retinal detachment.Methods To analysing retrospectively 24 cases of complicated retinal detachments.receiving retinotomy and retinectomy from Sept.1997 to Dec.1998.These cases include giant retinal tears with inverted retinal flap(15eyes),severe traumatic retinal detachment(2 eyes),proliferative vascular retinopahty(2 eyes),recurrent retinal detachment(3 eyes)and anterior proliferative retinopathy,The operative procedures of vitreoretinal(VR)surgery was involved scleral bucking,vitrectomy and/or lensectomy,the peeling of pre-retinal membrane,perfluorodecalin injection,and silicone oil or C 2F 6 after perfluorodeclin liquid-silicone oil or fluid-air exchange.Ten cases was recevied retinotomy,ten cases receving retinectomy and four cases receving retinotomy,and retinectomy respectivly.Results Discharge from the hospital,the operation was effective in 22 eyes(91.7%) and failure in 2 eyes(8.3%),19 eyes achieved improvement of visual acuity.14 out of 15 eyes of giant retinal tears with complicated retinal detachment were receiving by retinectomy of the stiff margins or relaxing retinotomy of the ends of retinal tears.The duration of followed up in 19 eyes was from 3 to 14 months,averging follow-up of 6 months.The retina kept attached was in 18 eyes(94.7%),and visual acuity better than 0.05 1n 9 eyes(50.0%),one eye resulted in hypotony(intraocular pressure=8 mmHg).Conclusion Retinoptomy and retinectomy were beneficial to improving the curative effect of complicated retinal detachment with severe proliferative vitreoretinopathy.