直视下巩膜环扎加压术治疗孔源性视网膜脱离的疗效观察

Observation of the effects of scleral buckling for treatment of rhegmatogenous retinal detachment

目的探讨直视下孔源性视网膜脱离复位手术的临床效果。方法孔源性视网膜脱离16例(16眼)由同一术者进行外路手术,术前三面镜下,间接检眼镜下仔细严格定位裂孔,术中肉眼下大致定位,全部行环扎并裂孔变性区外垫压,根据裂孔大小冷凝或非冷凝,尽可能安全放液,根据眼压,裂孔形态,部位选择注入气体填充物,定期观察术后视力、眼内反应和视网膜复位情况。结果 16例视网膜脱离手术患者,术后随访半年,视网膜完全复位14眼(87.5%),视力较术前提高12只眼(75%),不变3只眼(18.75%),不完全复位少量视网膜下液吸收缓慢1眼,再次脱离行玻璃体切割手术视网膜复位1眼(6.25%)。最好矫正视力0.1以上10只眼(62.5%)。结论手术前的仔细检查定位裂孔,环扎术避免遗漏裂孔及变性区均为直视下外路治疗孔源性视网膜脱离提供安全有效的保证,为眼科医师提供新的视网膜脱离手术方式的选择,且手术时间较短,操作相对简单,疗效有明确的保证。

Objetive To explore the clinical effect of scleral buckling for treatment of rhegmatogenous retinal detachment. Method 16 eyes of rhegmatogenous retinal detachment of 16 patients were performed scleral buckling by the same surgeon. We located retinal hole with three-mirror contact lens and indirect ophthalmoscope before operation, and performed scleral buckling and cryotherapy, Gas was tamponaded according to intraocular pressure and the shape and position of retinal holes. Visual acuity, intraoeular reaction and retinal reattachment were observed after operation. The follow-up was 6 months. Results The retina was completely reattaehed in 14 eyes （87.5%）, visual acuity was improved in 12 eyes （75%）, remained unchanged in 3 eyes （18.75%）. Subretinal fluid absorbed slowly in 1 eyes. 1 eye underwent vitrectomy because of non-reattachment （6.25%）. The best corrected visual acuity was more than 0.1 in 10 eyes （62.5%）. Conclusion Carefully locating the retinal hole and cryotherapy can guarantee the effects of treatment for rhegmatogenous retinal detachment.