微创玻璃体切割术联合生物胶治疗原发性孔源性视网膜脱离的疗效和安全性

  目的 探讨微创玻璃体切割术联合生物胶治疗原发性孔源性视网膜脱离的疗效和安全性。方法 选取2014-06至2017-06解放军总医院第三医学中心收治的原发性孔源性视网膜脱离患者21例,共21眼,微创玻璃体切割术(microincision vitrectomy surgeries, MIVS)联合应用生物胶来封闭视网膜裂孔,应用手术灌注液填充玻璃体腔。观察术中生物胶覆盖情况,以及术后视网膜复位成功率、矫正视力、眼压、炎性反应和并发症等情况。结果 术中生物胶与视网膜黏附良好,能成功封闭视网膜裂孔。通过间接检眼镜检查见生物胶膜在玻璃体切除术后(13.77±5.13)d已吸收。21例21只眼术中和术后视网膜复位成功,在随访期间视网膜脱离未复发。术后1年矫正视力0~2.15,平均(0.79±0.62),较术前矫正视力0~2.32,平均(0.93±0.74),显著提高。1例1只眼术后出现视网膜前膜,最终需要行前膜剥除术。2例2只眼术后7 d内出现一过性眼压升高,给予噻吗洛尔滴眼液治疗后眼压降至正常。出院随访期间未发现眼压异常情况。未发现明显的与生物胶相关的炎性反应或其他并发症。结论 MIVS中联合生物胶可成功封闭视网膜裂孔,促进孔源性脱离视网膜复位;眼内应用安全有效,可以作为MIVS联合气体填充的一种替代选择。

Safety and effect of microincision vitrectomy with bio-glues for retinal holes sealing in rhegmatogenous retinal detachment

Objective To evaluate the safety and effect of microincision vitrectomy and bio-glue in sealing retinal holes for primary rhegmatogenous retinal detachment.Methods Between June 2014 and June 2017, 21 cases of primary rhegmatogenous retinal detachment patients (21 eyes) were selected from our Department of Ophthalmology. All the 21 patients were given microinvision vitrectomy, during which bio-glue was used to seal the retinal holes. At the end of surgery, a balanced saline solution was used to fill the vitreous cavity. The glue membrane, first-time retinal reattachment rate, corrected visual acuity, intraocular pressure and intraocular inflammatory reaction and complications were observed.Results The bio-glue could adhere fast to the retina during microincision vitrectomy. The bio-glue membrane was absorbed at (13.77±5.13)days postoperatively. All the retinal holes were totally sealed after surgery. The first-time retinal reattachment rate was 100%. At 12 months after microincision vitrectomy, the corrected visual acuity was significantly improved from 0-2.32,average(0.93±0.74),to 0-2.15,average(0.79±0.62). One eye was diagnosed with epiretinal membrane after vitrectomy and was finally given membrane peeling surgery. Two eyes in two cases developed an abnormal intraocular pressure at 7 days after vitrectomy. With the use of Timolol, the pressure returned to normal. During vitrectomy and 12 months of follow-up, there was no obvious inflammation or adverse effect.Conclusions The joint application of vitrectomy and bio-glue can seal retinal holes properly without the use of gas. It can be a new alternative to rehgmatogenous retinal detachment during microincision vitrectomy.