同期行硅油取出C3F8填充联合巩膜扣带术治疗硅油填充术后下方视网膜脱离患者的手术疗效

目的　探讨同期行硅油取出Ｃ３Ｆ８填充联合巩膜扣带术治疗硅油填充术后下方视网膜脱离患者的手术疗效。方法　选取１２例１２眼硅油填充伴下方视网膜脱离的患者，采用硅油取出并玻璃体内Ｃ３Ｆ８填充联合巩膜扣带术进行治疗，术中根据情况选择性联合实施冷冻、激光、剥膜、外放液等；术后观察随访视网膜复位情况、视力、眼压和并发症等。患者随访观察时间为１１～２３（１８．３５±４．２２）个月。结果　术后２ｄ所有患者视网膜完全复位，随访期间发现３眼复发视网膜脱离，远期复位率７５％。术后视力较术前改善，差异有统计学意义（Ｐ＝０．０４７）。术后６眼出现一过性眼压升高，最高至３５ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），给予药物降压后，眼压回归正常，并保持稳定，停药后未有再升高。术后患者末次随访时眼压为１８～２２（１４．５３±５．４２）ｍｍＨｇ。与术前比较，眼压增高（ｔ＝－５．３１１，Ｐ＜０．００１）。因术前存在视网膜脱离，故术前患者眼压均偏低，术后眼压恢复正常后眼球萎缩的可能性下降。术中未出现视网膜损伤、出血、重水残留等并发症，但所有患者眼睑肿胀、结膜水肿明显，尤以术中冷冻者（４例）更为显著，患者自觉磨涩疼痛症状较为明显，术后２ｄ症状逐渐减轻。结论　对于玻璃体切除硅油填充术后下方视网膜脱离患者，同期行硅油取出Ｃ３Ｆ８填充联合巩膜扣带术能有效地使视网膜再复位，缩短治疗周期。

Silicone oil removal combined with scleral buckling and C3F8 tamponade for inferior retinal detachment after silicone oil filled

Objective To investigate the efficacy of silicone oil removal combined with scleral buckling and C3FS tamponade in treating the inferior retinal detachment in patients with silicone oil filled eyes. Methods Twenty eyes with inferior retinal detachment after silicone oil tamponade of 12 patients were recruited. All patients were treated with silicone oil removal combined with scleral buckling and C3 F8 tamponade. and membrane peeling, heavy water application, air-fluid exchange, endophotocoagulation , cryocoagulation ,laser , external drainage etc. The recovery of the detached retina . visual acuity ,intraocular pressure , and postoperative complications were evaluated. The follow-up time was from 11 months t0 23 months with means ( 18. 35 +4. 22) months. Results The rate of retinal attachment at 2 days after the operation was 100% . While recurrent retinal detachment appeared in 3 cases during the follow-up time. The rate of final retinal attachment was 75% . Visual acuity was improved after the operation statistically (P = 0. 047 ) . The intraocular pressure was transient elevated in 6 eyes,peaked at 35 mmHg ( I kPa = 7. 5 mmHg) , returned to normal after treated by drugs. The intraocular pressure at the final follow-up was ( 14. 53 + 5. 42 ) mmHg ( 18 - 22 mmHg) , which was higher than pre- operation statistically ( t = - 5 . 31 I ,P < 0. 001 ) . Complications such as bleeding , heavy water residues and retinal damage did not appear during the operation , but all patients had severe postoperative eyelid edema and conjunctival edema, especially those who accepted cryocoagulation (4 cases). Conclusion The surgery including silicone oil removal and scleral buckling and C3 Fs tamponade for inferior retinal detachment in patients with silicone oil filled eyes can effectively reattach the retina. It can reduce the economic costs for the patients . and reduce the treatment cycle.