巨大裂孔性视网膜脱离手术疗效分析

目的:评价巨大裂孔性视网膜脱离的手术治疗效果。方法:回顾性分析32例33眼巨大裂孔性视网膜脱离,采用巩膜扣带术(2眼)和平坦部玻璃体切除术联合20%C_3F_8(3眼)或硅油(28眼)充填,20眼切除晶状体,27眼使用过氟化碳、协助剥膜,使用冷凝(9眼)和(或)眼内氩激光(24眼)封闭裂孔。结果:术后随访6～42个月[平均(16.97±9.88)个月],26眼视网膜完全复位(78.8%),4眼黄斑复位,3眼未复位。复位的30眼中,术后视力低于0.02者4眼,0.02～0.04者3眼,0.05～0.08者2眼,0.1～0.3者14眼,0.4～0.7者7眼。结论:根据裂孔的情况正确选择手术方法和眼内充填物,大部分巨大裂孔性视网膜脱离患眼可脱盲。早期诊断、早期手术是巨大裂孔性视网膜脱离获得较好视力预后的关键,术后增生性玻璃体视网膜病变是导致手术失败的主要原因。眼科学报2003;19:71-74

Management of Giant Retinal Breaks

PURPOSE: To evaluate the management for eyes with retinal detachment due to giant retinal breaks. METHODS: Retrospectively, we reviewed 33 eyes of 32 cases treated either by scleral buckling (2 eyes) or by pars plana vitrectomy (PPV) combined with 20% C3F8(3 eyes) or silicone oil (28 eyes) tamponade. Of the 31 eyes undergone PPV, lensectomy was also performed on 20 eyes and perfluorocarbon was used to unroll and flatten the flap of the giant retinal breaks (GRBs) as well as to help peeling membranes in 27 eyes. Cryopexy (9 eyes) or endophotocoagulation (24 eyes) was applied to close the GRBs. RESULTS: After follow-up for 6-42 months (mean 16.97 +/- 9.88), total retinal reattachment was achieved in 26 eyes, macular reattachment in 4 eyes, and 3 eyes maintain detached. Of the reattached 30 eyes, the final acuity were less than 0.02 in 4 eyes, 0.02-0.04 in 3 eyes, 0.05-0.08 in 2 eyes, 0.1-0.3 in 14 eyes, 0.4-0.7 in 7 eyes. CONCLUSION: A majority of GRBs eyes may avoid blindness by appropriate surgical methods and intraocular tamponade according to the complexion of the GRBs. Early diagnosis and operation of GRBs are the main prerequisites of a better prognosis and results. Proliferative vitreo retinopathy (PVR) was the main cause of surgical failure.