玻璃体切割手术治疗急性视网膜坏死综合征的长期随访观察

目的 观察玻璃体切割手术(PPV)治疗急性视网膜坏死综合征(ARN)的长期效果.方法 回顾性分析17例ARN患者19只眼接受PPV治疗后随访观察1年及以上的临床资料.所有患者均经临床症状、裂隙灯显微镜以及间接检眼镜检查明确临床诊断.手术前最佳矫正视力(BCVA)无光感～0.1,1只眼为0.1,其中18只眼存在视网膜脱离.19只眼均行常规PPV治疗.19只眼分别接受1～5次手术,平均手术次数2.8次;18只眼接受再次或多次手术,占94.7%.治疗后随访观察12～120个月,平均随访时间44个月.分析首次PPV手术后视网膜复位情况;统计再次或多次手术的主要原因;对比观察治疗前后BCVA、眼压、视网膜以及眼球形态变化.结果 首次PPV手术后第1天17只眼视网膜完全复位.再次或多次手术的主要原因为单纯硅油取出(RSO)、增生性玻璃体视网膜病变(PVR)、低眼压和视网膜脱离.随访期间9只眼BCVA≥0.1,但末次随访时仅4只眼BCVA≥0.1.19只硅油眼的平均眼压12.7 mm Hg(1 mm Hg=0.133 kPa),其中15只眼RSO手术后平均眼压5.1 mm Hg.19只眼PPV手术后均发生了不同程度的PVR.末次随访时8只眼存在不同程度的眼球萎缩.结论 PPV治疗ARN的长期效果较差.

Long term follow-up of acute retinal necrosis syndrome treated by vitrectomy

Objective To investigate the long term efficacy of vitrectomy in the treatment of acute retinal necrosis syndrome (ARN). Methods The clinical data of 17 patients (19 eyes) with ARN underwent vitrectomy were retrospectively analyzed. The diagnosis of ARN was made by clinical symptoms,slit lamp and indirect ophthalmoscope examination. Preoperative best corrected visual acuity (BCVA)ranged from no light perception to 0. 1 (only one eye with 0. 1). Eighteen eyes had retinal detachment (RD). All 19 eyes underwent one to five times (on average of 2.8 times) conventional pars plana vitrectomy (PPV). 18/19 eyes (94.7%) underwent multiple times of PPV. The follow-up period ranged from 12 to 120 months with an average of 44 months. Results Complete retinal reattachment was achieved in 17/18 (88. 9%) eyes at the next day after the first PPV. The major indications for second or more times PPV included removal of silicon oil, proliferative retinopathy and hypotony. Nine eyes had a BCVA≥0.1 during the follow-up, but only four eyes had a BCVA≥0.1 at the end of follow-up. The mean IOP of 19 eyes with silicone oil tamponade was 12.7 mm Hg (1 mm Hg=0. 133 kPa), and the mean IOP of 15 eyes without silicone oil tamponade was 5.1 mm Hg. All eyes had variable degrees of postoperative proliferative retinopathy, and eight eyes developed atrophy of eyeball at the end of the follow-up. Conclusion PPV has no long-term beneficial effects on ARN.