"三脱離"手術時機和術式的選擇

目的討論伴脉絡膜脱離孔源性視網膜脱離的手術時機和方法,并證明術前不依賴糖皮質激素治療的可行性.方法針對其特徵性臨床表現就術前是否使用糖皮質激素,采用放舆不放視網膜脱離下液兩種手術方法.結果視網膜一次復位率激素組88.6%、非激素組91.6%,兩組手術效果比較P>0.05,但激素組放液致脉絡膜出血1例.而非激素組采用不放液手術則并發癥少,并在裂孔封閉後,視網膜脉絡膜復位、炎癥自然消退、玻璃體狀態改善.結論盡早手術封閉裂孔是治療的關鍵;即使術前不用激素治療,祗要手術時機和手術方法選擇適當,也能達到很好的療效.

Timing and techniques of operation in rhegmatogenous retinal detachment associated with ciliochoroidal detachment

Objective To investigate into timing and techniques of operation for rhegmetogenous retinal detachment with ciliochoroidal detachment (CRRD) and the outcome of operation for CRRD without preoperative hormone therapy. Methods On 22 cases, surgery was performed without steroid treatment or drainage. On the other 22 cases, surgery was performed with preoperative steroid treatment and subsequently, drainage to remove excessive subretinal fluid. Results The reattachment rate was 88.6% and 91.6% in steroid-treated and non-steroid-treated group, respectively (P>0.05). In the treated group, one operation failed due to choroidal hemorrhage. In the non-steroid-treated group, there were few complications; after the closure of the hole, inflammation disappeared naturally, vitreous condition improved and retina as well as choroidea reattached. Conclusion Early operation is key to the success for CRRD patients. Good timing and proper technique can achieve desirable effect even without hormone treatment.