合并视网膜下增生的儿童孔源性视网膜脱离手术

目的观察巩膜扣带术和玻璃体切除术两种手术方式治疗先天异常因素所致儿童视网膜脱离的近期疗效。方法儿童48例（56眼）先天异常因素所致视网膜脱离行巩膜扣带术和玻璃体切除术48例（56眼）。结果（1）巩膜扣带术33眼：随访6个月以上一次手术视网膜平伏20眼（60．81％）；残留网膜下液7眼，无效6眼。（2）玻璃体切除手术23眼：随访6个月一次手术视网膜复位14眼（60．86％）；二次手术视网膜复位6眼，3眼视网膜浅脱离，未取硅油。从近期疗效看，两种手术方式的一次手术成功率和视功能恢复程度的差异无统计学意义（P〉0．05）。结论儿童先天异常因素所致视网膜脱离如增生不重可优先考虑巩膜扣带术，如网膜不能平伏，再行玻璃体切除手术，但远期疗效需待进一步观察。

Surgical outcomes of pediatric rhegmatogenous retinal detachment with subretinal proliferation

Objective To observe therapeutic effects of the scleral buckling and vitrectomy in juvenile retinal detachment caused by congenital abnormalities. Methods 48 patients 56 eyes were diagnosed as rhegmatogenous retinal detachment caused by congenital causes in Southwest Eye Hospital from July of 2007 to January of 2010. All have had scleral buckling or vitrectomy respectively. Results The follow-up time was 6 months or further. Thirty-three eyes had scleral buckling: the retina of 20 eyes had been once reattached, 7 eyes had rudimental subretinal fluid, the retinal of 6 eyes hadn't been reattached. Twenty-three eyes had vitrectomy with silicone oil taken out after 3 to 7 months, the follow-up time was 6 months or further, the retina of 14 eyes had been once reattached, the retina of 6 eyes had been reattached again. 3 eyes still had retinal detachment. As to the near therapeutic effects, the reattached rate and visual outcomes of two surgical methods had no statistical disparity (P>0.05).Conclusions The first surgical choice of juvenile retinal detachment with mild to moderate proliferation caused by congenital abnormalities was scleral bucking. Vitrectomy should be considered if the retina hadn't been reattached, but the further therapeutic effects should be observed.