闭合式三切口玻璃体视网膜手术治疗4期和5期早产儿视网膜病变

目的：探讨闭合式三切口玻璃体视网膜手术治疗4期和5期早产儿视 网膜病变（ROP）的临 床效果。方法：回顾性分析26例ROP患儿32只眼行闭合式玻璃体视网膜手 术治疗的临床资料。其中， 男性18例，女性8例；出生孕周27~35周，平均孕周29.4周；出生体重960~2200 g，平均体 重 1434.6 g。手术时年龄为出生后50~705 d，平均158.3 d。32只眼中ROP5期病变13只眼 ， 4期病变19只眼（4A期10只眼，4B期9只眼）。其中11只眼因ROP阈值病变或阈值前病变1型接 受间接检眼镜激光光凝治疗，1只眼再次接受冷冻治疗，病变未能控制进展至4期或5期。玻 璃体视网膜手术采用闭合式三切口入路，其中11只眼保留晶状体，21只眼行晶状体切除。手 术后随访 2~24个月，主要随访视网膜复位情况。结果：所有患儿手术过程顺利。4 期的19只眼中，4A期 的10只眼视网膜均完全复位，占100%。3只眼有视盘黄斑牵引；4只眼分别于视盘前、鼻侧视 网膜前及颞侧周边部残余机化增生膜；1只眼手术后玻璃体少量积血，2周后吸收；1只眼手 术 后并发白内障。4B期的9只眼，视网膜完全复位6只眼，占66.7%。但均周边广泛瘢痕机化 ，1只眼有视盘黄斑牵引；另外3只眼视网膜未复位，手术后即有玻璃体积血，其中2只眼合 并前房积血。5期的13只眼，3只眼视网膜完全复位，占23.1%。其中2只眼周边广泛瘢痕机 化，视网膜血管细，视盘色淡；1只眼颞侧视网膜皱襞；1只眼视网膜大部分复位，占7.7% ，鼻侧视网膜有增生膜和浅脱离；另外7只眼视网膜均未复位。结论：4 期ROP 通过保留或不保留晶状 体的闭合式三切口玻璃体视网膜手术治疗，能够使视网膜有效解剖复位，手术成功率较高； 但对于5期ROP，玻璃体视网膜手术效果差，成功率较低。

Vitrectomy with closed triple incisions for stage 4 or 5 retinopathy of prematnrity

Objective To observe the clinical therapeutic effect of v itrectomy with closed triple incisions on stage 4 or 5 retinopathy of prematurity (ROP). Methods The clinical data of 32 eyes of 26 infants with stage 4 or 5 ROP who un derwent vitrectomy with closed triple incisions from Jan. 2003 to Jan. 2007 were retrospectively analyzed. The 26 infants included 18 males and 8 females, with the gestational age of 27－35 weeks (average 29.4 weeks) and the birth weight of 960－2200 g (average 1434.6 g). The age at the operation was 50-705 days with t he average of 158.3 days. In these 32 eyes, stage 5 ROP was in 13, stage 4 ROP was in 19 (stage 4A in 10 and 4B in 9) in which 11 eyes underwent indirect ophthal m oscope photocoagulation because of threshold and type 1 pre threshold ROP and 1 eye underwent cryotherapy again with the disease developing into stage 4 or 5. T he entrance of vitrectomy was closed triple incisions. The lens were saved in 11 eyes and removed in 21 eyes. The follow up duration was 2-24 months and the c ondition of retinal reattachment was observed. Results The procedures of operative therapies on 26 affected infants ran smooth. In the 19 eyes at stage 4 ROP, the retina reattached completely in 10 at stage 4A (100%), in which macular traction at optic disc was in 3, remained proliferative membran e in front of the optic disc, in front of the nasal retina and at the peripheral area of the temporal side was found in 4, few vitreous hemorrhage after the ope ration was in 1 which was absorbed 2 weeks later, and cataract after the operati on was in 1; in 9 eyes at stage 4B, retina reattached completely in 6 (66.7%), m acular traction at optic disc was in 1, and retina remained detached in 3 with v itreous hemorrhage after the operation including 2 eyes with anterior chamber he morrhage. In 13 eyes at stage 5, retinal reattached completely in 3 (23.1%) in w hich scars in the peripheral retina, thin retinal vessels and pale optic disc wa s found in 2 and retinal rumple at the temporal side was found in 1; retina reat tached mostly in 1 eye (7.7%) with retinal proliferative membrane and slight re t inal detachment at the nasal side; retina remained detached in 7 eyes.Conclusion Vitrectomy with closed triple incisions for stage 4 ROP may lead the retina l reattachment effectively, but the therapeutic effect is not good on the infant s with stage 5 ROP.