曲安奈德玻璃体内注射联合23G微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效分析

目的　探讨曲安奈德玻璃体内注射联合２３Ｇ微创玻璃体切割术治疗脉络膜脱离型视网膜脱离的疗效。方法　２０１２年１月至２０１３年１月在我院就诊的２８例脉络膜脱离型视网膜脱离患者，经过术前短期糖皮质激素治疗后，行２３Ｇ微创玻璃体切割术治疗，术中联合玻璃体内注射曲安奈德４ｍｇ，术后随访６～１２个月，观察术后视力恢复、视网膜复位和并发症发生情况。结果　一次手术视网膜解剖复位率为８９．３％，再次术后视网膜解剖复位率１００．０％。术前ＬｏｇＭＡＲ视力为１．９８±０．５０，术后ＬｏｇＭＡＲ视力为１．１７±０．４０，差异有统计学意义（ｔ＝８．３７１，Ｐ＜０. ０５）。末次随访眼压（１６．２±３．７）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），与术前眼压（６．４±２．３）ｍｍＨｇ相比，差异有统计学意义（ｔ＝１７. ６１３，Ｐ＜０．０５）。术后有１５例出现一过性高眼压，３例白内障加重，１例发生后发性白内障，５例术后少量结膜下出血。结论　２３Ｇ微创玻璃体切割术联合术中曲安奈德玻璃体内注射治疗脉络膜脱离型视网膜脱离是安全有效的。

23-gauge micro-invasive vitrectomy combined with triamicinolone acetonide intravitreal injection for retinal detachment associated with choroidal detachment

Objective To discuss the effects of 23-Gauge micro-invasive vitrectomy combined with triamicinolone acetonide intravitreal injection for retinal detachment associated with choroidal detachment. Methods Twenty-eighth cases of retinal detachment associated with choroidal detachment in our hospital from January 2012 to January 2013 were treated by 23-Gauge nucro-invasive vitrectomy combined with preoperative systemic steroid and intravitreal injection of 4 mg triamcinolone acetonide during operation. All the cases were followed-up for 6 t0 12 months. The anatomic retinal reattachment.visual acuity and postoperative complications were observed. Results The retinal reattachment rate after the primary surgery and the second surgery was 89. 3% and 100. 0% , respectively. The preoperative and postoperative LogMAR visual acuity were l. 98 + 0. 50 and I . 17 + 0. 40 , respectively , the difference was significant statistically ( t = 8. 371 ,P < 0. 05 ) . The intraocular pressure at last visit was ( 16. 2 + 3. 7 ) mmHg ( I kPa = 7. 5 mmHg) , which was statistically significant higher than pre-operation ( 6. 4 + 2. 3 ) mmHg , the difference was significant statistically ( t = 17 . 613 .P < 0. 05 ) . Post-operative complications included 15 cases of transient high intraocular pressure.3 cases of cataract,l case of posterior capsular opacification and 5 cases of mild subconjunctival hemmorhage. Conclusion 23-gauge micro-invasive vitrectomy combined with intravitreal injection of triamcinolone acetonide during operation is effective and safe for retinal detachment associated with choroidal detachment.