非常复杂型视网膜脱离的治疗探讨

目的:探讨治疗非常复杂型视网膜脱离的方法。方法:31例(31眼)非常复杂型视网膜脱离,包括原发性裂孔性视网膜脱离伴PVR-D3级及前段玻璃体严重增殖者14只眼;巨大裂孔性视网膜脱离伴严重PVR 8只眼;严重眼外伤伴眼内容物脱出及严重PVR 9只眼。采用巩膜冷凝、环扎、硅胶填压、玻璃体切割、视网膜前膜剥离/切除,视网膜松解性切开,过氟化碳液体注入,眼内/眼外排液以及硅油眼内填充等方法治疗。结果:随访3～16个月,31眼中,21只眼视网膜完全复位,占67.7％;5只眼大部分复位,占16.1％;5只眼未能复位,占16.1％。术后视力,除了失败的5只眼外,在其余的26只眼中,有一眼视力较术前下降,其余25只眼的视力均有不同程度的提高。结论:PVR及巨大裂孔性视网膜脱离的效果较好,分别有71.4％及87.5％完全复位,严重外伤的治疗效果较差。眼科学报1998;14:90—93。

Management of Very Complicated Retinal Detachment

Purpose:To evaluate the management for a group of complicated retinal detachment in very severe conditions including(A) rhegmatogenous retinal detachment associated with severe posterior and anterior PVR, (B) giant retinal tear (GRT) retinal detachment with severe PVR, (C)severe perforating eye injury with tractional retinal detachment.Methods:A total number of 31 eyes from 31 patients was included,in which 14 eyes were in group A, 8 eyes were group B and 9 eyes group C. Procedures including scleral buckling, encircling, cryotherapy, total vitrectomy, epiretinal membrane peeling/excision, relaxing retinectomy, use of perfluorocarbon liquid and silicone oil were applied to all patients. Patients were followed up for three to 16 months. Results :Retinas of 21 out of 31 eyes(67.7% )were completely reattached and 5 eyes (16.1%) were partially reattached, 5 eyes were failed( 16.1 %). Postoperative vision was significantly improved in 25 eyes. The visual acuity of 19 eyes was better than 0.02, while before operation only two eyes were better than 0.02. PVR and GRT patients had better results.Conclusion: The results showed that a big part of very complicated retinal detachment which was called as hopeless cases could still be successfully treated with comprehensive procedures,more than half of them may have useful vision which may obviously improve their life quality. Eye Science 1998; 14: 90 - 93.