视网膜下膜取出术治疗Vogt-小柳-原田病合并黄斑区视网膜下膜的临床疗效

  目的  观察视网膜下膜取出术治疗Vogt-小柳-原田病(Vogt-Koyanagi-Harada disease, VKH)合并黄斑区视网膜下膜的临床疗效。  方法  回顾性分析2008年1月至2011年12月在北京协和医院行玻璃体切除+视网膜下膜取出术的VKH患者的临床资料。  结果  3例VKH患者共4只眼接受了视网膜下膜取出术。患者中男2例, 女1例, 平均年龄40.7岁(31~48岁)。接受视网膜下膜取出术的4只眼中, 术前均有黄斑区视网膜下膜, 最佳矫正视力在光感至0.06之间; 2只眼术前无白内障, 1只眼合并轻度白内障, 1只眼合并重度白内障。所有患眼在术中均行玻璃体大部切除+视网膜切开+视网膜下膜取出术; 合并重度白内障的患眼术中行后路晶体切除术; 1只眼术中行C₃F₈填充, 另3只眼行硅油填充。所有患者围术期无严重并发症。随访过程中, 3只行硅油填充术的患眼均行二期硅油取出术, 术后随诊过程中均无视网膜脱离。2只术前无白内障的患眼在随访过程中均出现白内障并影响视力, 均成功施行白内障超声乳化吸除术+人工晶体植入术。术前有轻度白内障的患眼行硅油取出术的同时行后路晶体切除+人工晶体植入术。末次随诊在最后一次手术后1~6个月, 平均3.8个月, 均无活动性的前后节炎症。4只眼的末次随诊视力较第1次术前均有所提高。  结论  视网膜下膜取出术是治疗VKH合并黄斑区视网膜下膜的有效方法; 下膜取出术后常出现白内障, 需要手术治疗。

Efficacy of Surgical Removal of Subretinal Fibrosis in Patients with Vogt-Koyanagi-Harada Disease

Objective To evaluate the clinical efficacy of surgical removal of subretinal fibrosis in patients with Vogt-Koyanagi-Harada disease （VKH）. Methods The clinical data of VKH patients who underwent trans pars plana vitrectomy and subretinal fibrosis removal in our hospital from January 2008 to December 2011 were retrospectively analyzed. Results Two male and one female VKH patients （4 eyes） , with an average age of 40. 7 years （31 to 48 years）, were included in this case series. Before surgery, of the 4 eyes, all had subreti- nal fibrosis in the macula, 1 had mild cataract, and 1 had severe cataract. All the 4 eyes underwent conventional 20-gauge trans pars plana vitrectomy, retinotomy and subretinal fibrosis removal, of which 1 eye was tamponed with Ca Fs and the rest 3 were tamponed with silicon oil. An additional lensectomy preserving the anterior capsule with intraocular lens （IOL） implantation was performed in the eye with severe cataract during vitrectomy. No severe perioperative complication was observed. All the 3 silicon oil tamponed eyes underwent successful surgical removal of silicon oil without retinal detachment during follow-up. The 2 eyes without preoperative cataract devel- oped cataract during the follow-up after subretinal fibrosis removal and were successfully treated with phacoemulsi- fication and IOL implantation. Exacerbation of cataract was observed in the eye with mild preoperative cataract and was treated with trans pars plana lensectomy preserving the anterior capsule with IOL implantation during sili- con oil removal surgery. The patients were followed up for 1 to 6 months after the last surgical intervention （3.8 months on average） and no active ocular inflammation was observed. When compared to preoperative conditions, improvement in visual acuity was observed in all the 4 eyes in the last follow up visit. Conclusions Surgical removal may be a potentially effective treatment for subretinal fibrosis in the macula in VKH patients. Cataract is a common complication after this surgery and requires further surgical intervention.