内界膜剥除联合视网膜切开治疗复杂眼创伤视网膜脱离的疗效观察

目的研究内界膜剥除联合视网膜切开在治疗创伤性视网膜脱离的临床意义。方法笔者对2012~2014年收治的开放性眼创伤所致视网膜脱离患者49例49眼进行前瞻性分析,所有患者增生性玻璃体视网膜病变分级(PVR)均为C3以上。将患者随机分为两组,A组22眼,术中广泛剥除内界膜联合周边视网膜大范围切开;B组27眼,行常规玻切手术治疗,并剪除视网膜牵引。随访时间6个月~2年,平均7.5个月,对比观察两组术后视力恢复情况、再次视网膜脱离发生率及术后黄斑前膜发生率。结果两组术前PVR分级及视力比较均无统计学差异(P0.05);患者术后再次视网膜脱离发生率:A组术后发生2眼(9.1%),B组11眼(40.7%),两组间卡方值为6.229,P值为0.0125;术后光学相干断层扫描(OCT)检查A组中再次发现黄斑前膜1眼(4.5%),B组9眼(33.3%),两组间卡方检验,卡方值为4.540,P值0.033,均有统计学意义。结论 A组剥除后极部内界膜患者,术后最佳矫正视力比较与B组差别不大,P值无统计学差异,但发生复发性视网膜脱离及黄斑前膜概率均低于未剥离组,且差别有统计学意义。

Effect of internal limiting membrane peeling and retinotomy in the treatment of traumatic retinal detachment

Objective To investigate the clinical value of a combination of internal limiting membrane peeling and retinotomy in the treatment of traumatic retinal detachment .Methods A prospective analysis was con-ducted on 49 eyes of 49 patients with retinal detachment caused by open eye injuries admitted in the hospital from 2012 to 2014.These patients were randomly divided into two groups: group A (22 eyes) received intra-operative extensive peeling of internal limiting membrane in combination with a large range of peripheral retinotomy ;group B (27 eyes) received conventional vitreous surgical treatment and extermination of retinal traction .During an average follow-up of 6 months to 2 years,postoperative visual recovery,the incidence of recurrent retinal detachment and postoperative incidence of epimacular membrane in the two groups were observed and compared .Results Preoper-ative PVR classification and vision were compared between the two groups ,with no statistically significant difference ( P>0.05);The incidences of recurrent retinal detachment during follow-up were as follows: postoperative retinal detachment occurred in 2 eyes (9.1%) in group A and 11 eyes (40.7%) in group B;chi-square value between the two groups was 6.229;and P value was 0.0125.Postoperative OCT examination showed epimacular membrane in 1 eye (4.5%) for group A and in 9 eyes (33.3%,χ2 =4.540,P=0.033) for group B.Conclusion For patients ith internal limiting membrane peeling at the posterior pole in group A ,the best corrected visual acuity after operation was comparable to that in group B ,with no statistically significant difference .However,the probabilities of occur-rence of recurrent retinal detachment and epimacular membrane in group A were lower than those in group B ,with statistically significant differences .