独眼视网膜脱离的临床特征及其治疗观察

目的探讨独眼视网膜脱离的临床特征及其治疗效果。方法复习西京医院眼科2002年1月至2007年5月间住院的、资料完整的、一眼已失明而残存眼(独眼)发生视网膜脱离的病例资料,分析对侧眼失明原因,总结独眼视网膜脱离的临床特点,观察其治疗效果。共包括105例独眼视网膜脱离患者,其中42例首次行巩膜外垫压(包括环扎)术,44例首次接受玻璃体手术,8例行单纯玻璃体内注气(C3F8)术,4例激光光凝术治疗;7例未行特殊治疗而失访。经治疗的98例患者随访6个月至1年。结果本组接受手术治疗的94例患者中一次手术后有72例视网膜复位(76.6%)。其中42例行巩膜外垫压术,一次手术视网膜复位率为74.0%(31/42);44例接受玻璃体切除术,复位率为82.0%(36/44);8例行玻璃体内注气术后,5例视网膜复位(62.5%)。经再次手术后,最终视网复位率为93.6%(88/94只眼)。接受治疗的98例患者中,66.3%(65/98只眼)术后视力提高。结论尽管独眼视网膜脱离患者的疾病特点与一般视网膜脱离无明显差别,但在社会学和人文方面有其特殊性,在选择治疗时,建议采取尽量保守的手术方案更符合患者长远利益;对经选择的病例,巩膜外垫压术的远期效果可靠。

Clinical investigation of features and outcomes of retinal detachment in monocular patients

Objective To investigate the clinical features and outcomes of retinal detachment（RD） in monocular patients.Methods Data of 105 consecutive inpatients were retrospectively reviewed,who underwent RD in the only eye,with the other eye lost vision already,and were treated from January 2002 to May 2007 in Department of Ophthalmology,Xijing Hospital.In order to investigate the clinical characteristic and treatment of RD in one-eyed patients,both the clinical charts and reasons for vision loss in the other eye were analyzed.For all 105 patients,42 were initially operated on with scleral buckling（with or without cerclage）,44 were primarily performed pars plana vitrectomy,8 were treated with pneumatic retinopexy（C3F8）,4 underwent laser photocoagulation,and 7 gave up treatment.Ninety eight treated patients have been followed-up for 6 to 12 months.Results In 72（76.6%） out of total 94 patients with surgical treatment,retinas were reattached after the first operation.These reattachment rates were 74.0%（31/42） in 42 cases underwent scleral buckling,82.0%（36/44） in 44 cases with pars plana vitrectomy,and 62.5%（5/8） in 8 cases of pneumatic retinopexy.Altogether,the curative ratio of RD was 93.6%（88/94） after the second operation.The visual acuity improved in 65 patients（66.3%）.Conclusion There is no significant difference of RD features between regular and monocular patients.However,considering the social and humanity effects,it is better for the patients to choose the relatively conservative surgical approaches in the long run,and in selected patients,scleral buckling is really effective with stability and longevity.