改良穿刺放液在外路法视网膜脱离复位术中的应用

目的 探讨外路法视网膜脱离复位手术中改良穿刺放视网膜下液的临床有效性及安全性.设计回顾性病例系列.研究对象2006年1月至2009年9月收住南京医科大学第一附属医院眼科的329例孔源性视网膜脱离的患者.方法 手术显微镜下予巩膜环扎和（或）巩膜外加压术,术中均联合改良穿刺法放出视网膜下液,即穿刺点选在角巩膜缘后11 mm的直肌两侧,避开涡状静脉和视网膜裂孔,采用25 G 5/8-in针头（1ml BD针头,新加坡Becton Dickinson Medical（S）Pte Ltd.）垂直巩膜穿刺放出视网膜下液,穿刺深度不超过针头斜面.收集术前、术后及手术数据并进行分析.主要指标改良穿刺放液的成功率及并发症的发生率.结果 329例外路法视网膜脱离复位手术,327例（99.4%）引流出视网膜下液,2例未引流出视网膜下液.改良穿刺放液的并发症有视网膜下出血2例（0.6%）,出血范围小于2PD,穿刺点正对视网膜裂孔处1例（0.3%）,导致玻璃体自巩膜穿刺口脱出.结论 改良穿刺放液法是外路法视网膜脱离复位术中引流视网膜下液的一种安全、有效的方法.

Modified needle drainage of subretinal fluid in scleral buckling surgery

Objective To discuss the effect and safety of modified needle drainage of subretinal fluid in external-route retinal detachment surgery. Design Retrospective case series. Participants 329 patients （329 eyes） with rhegmatogenous retinal detachment. Methods All the patients underwent scleral buckling surgeries with modified subretinal fluid drainage under ophthalmological surgical microscopy. A 25 gauge, 5/8 inch needle （1 ml BD needle, manufactured by Beeton Dickinson Medical （S） Pte Ltd. , Singapore ） was positioned vertically at 11 mm posterior to the limbus cornea and beside the rectus muscle, away from the vortex vein and retina break. The needle bevel length was the limit of penetrating depth. The data before, during and after surgeries was collected and analyzed. Main Outcome Measures Success rate and complications of modified needle drainage. Results Success rate of modified subretinal fluid drainage was 99.4%, while it failed in 2 eyes. Complications occurred in 3 eyes in the procedure. Two eyes （0.6%） had subretinal hemorrhage less than 2 PD. One had vitreous incarceration , because the drainage site was just at the retina tear. Conclusion Modified needle drainage of subretinal fluid is a safe and effective method to drain subretinal fluid in the external-route retinal detachment surgery.