人工晶状体植入结合异体巩膜治疗玻璃体积血伴视网膜脱离的效果分析

目的　探讨人工晶状体植入结合异体巩膜治疗玻璃体积血伴视网膜脱离的效果。方法　选择我院２０１３年７月至２０１５年６月收治的玻璃体积血伴视网膜脱离患者１２２例（１２２眼），根据抽签原则分为治疗组与对照组各６１例，对照组给予常规玻璃体切割＋人工晶状体植入手术，治疗组在对照组治疗的基础上给予异体巩膜治疗。观察两组最佳裸眼视力、视网膜复位率、角膜内皮细胞丢失率及并发症情况。结果　所有患者手术过程顺利，术中无严重并发症发生。术后１个月两组的最佳裸眼视力都得到明显提高，同时术后１个月治疗组的最佳裸眼视力明显好于对照组（Ｐ＜０．０５）。治疗组与对照组术后１个月的角膜内皮细胞丢失率分别为（１０．３４±２．４５）％和（１５．８７±３．１３）％，组间对比差异有统计学意义（Ｐ＜０．０５）。治疗组术后１个月的角膜水肿、葡萄膜炎症反应、低眼压、黄斑水肿等并发症总体发生率为４．９％，明显低于对照组的２３．０％（Ｐ＜０．０５）。治疗组术后１个月与６个月的视网膜脱离复位率分别为９１．８％和１００．０％，对照组分别为７３．８％和９０．２％，治疗组的视网膜脱离复位率均明显高于对照组（均为Ｐ＜０．０５）。结论　人工晶状体植入结合异体巩膜治疗玻璃体积血伴视网膜脱离能改善患者视力，有利于视网膜的复位，减少角膜内皮细胞的丢失，安全性好，有很好的推广应用价值。

Effects of intraocular lens implantation combined with xenogenic sclera for vitreous hemorrhage with retinal detachment

Objective To investigate the effects of intraocular lens implantation combined with xenogenic sclera for vitreous hemorrhage with retinal detachment. Methods From July 2013 to June 2015 ,122 patients ( 122 eyes) with vitreous hemorthage and retinal detachment in our hospital were selected. based on ballot principle there were equally divided into treatment group and the control group,61 patients in each group , the control group were given conventional vitrectomy and intraocular lens implantation .the treatment group were added sclera treatment on the basis of the control group. The best corrected visual acuity , retinal reattachment rate , retinal endothelial cell loss rate and complication were observed. Results All patients ’ surgery were went smoothly and had no serious complications. The best uncorrected visual acuity in both groups at postoperative I month were significantly improved.while the treatment group was sigruficantly better than the control group ( P < 0. 05 ) . The corneal endothelial cell loss rates in the treatment group and control group at postoperative l month were ( 10. 34 + 2. 45 ) % and ( 15. 87 + 3. 13 ) % , respectively , the difference was statistically significant between two groups ( P < 0. 05 ) . The overall incidence of corneal edema . uveitis . hypotony,macular edema and other complications in the treatment group at postoperative I month was 4. g% ,which were significantly lower than 23. 0% in the control group (P < 0. 05 ) . The retinal reattachment rates in the treatment group at postoperative I month and 6 months were 91. 8% and 100. 0% ,respectively , which in the control group were 73. 8% and 90. 2% , respectively ( all P < 0. 05 ) . Conclusion Intraocular lens implantation combined with xenogenic sclera for vitreous hemorrhage with retinal detachment can improve visual acuity ,increase the retinal reattachment rate and reduce the loss of corneal endothelial cells with good security.