内窥镜引导玻璃体视网膜手术治疗伴有角膜混浊的外伤性视网膜脱离

目的探讨眼内窥镜引导玻璃体视网膜手术治疗伴有角膜混浊的外伤性视网膜脱离的效果及安全性。方法 2010年8月至2011年6月我院13例(13眼)伴有角膜混浊的外伤性视网膜脱离患者,在眼内窥镜引导下行玻璃体切割、视网膜激光光凝术及玻璃体硅油或重硅油填充术,术后随访6～15个月,观察视力、眼压、眼前段及眼底视网膜复位情况。患者术前视力:无光感者2眼,光感者5眼,手动者3眼,数指者2眼,0.02～0.05者1眼。结果所有患者视网膜均平伏,裂孔均封闭。术中1眼玻璃体内发现术前未能诊断的非磁性异物(睫毛)。术后4眼早期眼压偏低,2眼一过性眼压增高,经观察或药物治疗后恢复正常。术后6个月最佳矫正视力:无光感者2眼,光感者2眼,手动者2眼,数指者5眼,0.02～0.20者2眼。结论眼内窥镜扩展了玻璃体切割术的适应范围,提高了对伴有角膜混浊的外伤性视网膜脱离,尤其是伴有周边部视网膜裂孔者,实施玻璃体视网膜手术的准确性和安全性。

Endoscope-guided vitreoretinal surgery on traumatic retinal detachment with corneal opacity

Objective To investigate the effect and safety of endoscope-guided vitreoretinal surgery on traumatic retinal detachment with corneal opacity.Methods Between August 2010 to June 2011,13 patients of traumatic retinal detachment with corneal opacity were enrolled in the study.Instead of conventional vitrectomy,endoscopy-guided vitreoretinal surgery,which including pars plana vitrectomy,photocoagulation and silicone oil/heavy silicone oil vitreous cavity tamponade,was performed.The follow-up time was from 6 months to 15 months,visual acuity,intraocular pressure,anterior ocular segment and retinal reposition were observed.The preoperative visual acuity was no light perception in 2 eyes,light perception in 5 eyes,hand movement in 3 eyes,figure counting in 2 eyes,from 0.02 to 0.5 in 1 eye.Results During the follow-up,the retina of all patients was successfully reattached with the aid of silicon oil/heavy silicone oil tamponade.The eye lash was found in vitreous of 1 eye,who did not diagnosed before operation.Ocular hypotension appeared in 4 eyes at early stage,and ocular hypertension in 2 cases,which returned to normal through observation or drug treatment.The best corrected visual acuity at postoperative 6 months was no light perception in 2 eyes,light perception in 2 eyes,hand movement in 2 eyes,figure counting in 5 eyes,from 0.02 to 0.20 in 2 eyes.Conclusion Ocular endoscope widens the indication of vitrectomy,and has been proved to be useful and safely for the management of traumatic retinal detachment with corneal opacity,especially for which retinal holes are on peripheral retina.