急诊充气性视网膜固定联合气体下激光光凝术治疗视网膜脱离

目的: 探讨充气性视网膜固定术联合气体下激光光凝急诊治疗视网膜脱离的临床疗效、治疗适应证、并发症处理及操作技巧。方法: 分析2011-09/2012-06在我科住院治疗的,PVR级别低于C级、裂孔位于上方6个钟点位的单纯孔源性视网膜脱离患者45例45眼,行充气性视网膜固定术,术后24～48h行气体下裂孔激光光凝术。观察视网膜复位率、最佳矫正视力和并发症。结果: 平均随访10mo。一次手术成功率40眼(88.9%)。术后视网膜下小气泡2眼(4.4%),视网膜下液吸收延迟3眼(6.7%)。新发视网膜裂孔5眼(11.1%),发展为牵拉性视网膜脱离2眼(4.4%),白内障加重1眼(2.2%)。结论: 充气性视网膜固定术联合气下光凝术适用于上方6个钟点位视网膜裂孔和PVR低于C级的病例。与玻璃体视网膜手术或巩膜扣带术相比,该术式能在发现孔源性视网膜脱离后迅速进行视网膜裂孔封闭,治疗环境及医疗设备要求相对宽松,手术技巧难度较低,治疗费用低。其缺点是一次手术成功率较低,术后需要精确的体位控制和密切随访。

Emergency management of retinal detachment with pneumatic retinopexy and laser photocoagulation

AIM: To evaluate the effects, surgical indications, complications and technique of pneumatic retinopexy(PR)combined with postoperative laser photocoagulation for the emergency treatment of retinal detachment.

METHODS: A review of 45 consecutive eyes of 45 patients who underwent PR for uncomplicated rhegmatogenous retinal detachment with superior retinal breaks at 6 o'clock and PVR stage lower than C from September 2011 to June 2012. Laser photocoagulation was performed at 24-48 hours after surgery. Primary and final anatomic outcomes, visual acuity, and adverse events were recorded.

RESULTS: The follow-up period was 3-15 months, with the mean of 10 months. The single-procedure reattachment rate was 40 eyes(88.9%). Postoperative subretinal bubble in 2 eyes(4.4%), subretinal fluid was absorded delay in 3 eyes(6.7%). New retinal hole in 5 eyes(11.1%), became tractional detachment of retina in 2 eyes(4.4%), cataract aggravated in 1 eye(2.2%).

CONCLUSION: PR with postoperative laser photocoagulation was applied to retinal detachment, which only with superior retinal hole and PVR stage be lower than C. Compared with vitreo-retinal surgery(V-R)and conventional scleral buckling(SB), PR closed retinal hole fleetly after found out rhegmatogenous retinal detachment. The requirements of therapeutic environment and armarium of PR are not so strict.The technique was simple. Treatment cost is cheap. But the single-procedure reattachment rate is low. It must be keep the posture with fidelity and follow up intimately.