无放液最小量巩膜外加压术治疗孔源性视网膜脱离

Minimal Scleral Buckling without Sub-retinal Drainage for Rhegmatogenous Retinal Detachment:an Analysis of 30 Cases

目的探讨最小量巩膜外加压治疗孔源性视网膜脱离的疗效和并发症。方法回顾性分析北京协和医院单纯孔源性视网膜脱离采用无放液、最小量巩膜外硅海绵加压术治疗28例患者30只眼,术前术后视力变化、视网膜复位情况及并发症。结果采用无放液、最小量巩膜外加压治疗的28例患者30只眼中巩膜外硅海绵加压缝合1针13只眼,缝合2针14只眼(其中1只眼2个裂孔分开,分别进行巩膜外加压1针),缝合3针及以上3只眼。术前最佳矫正视力(best corrected visual acuity,BCVA)<0.1为14只眼,0.1～0.3为8只眼,>0.3为8只眼。术后平均随诊(9.4±2.5)个月,术后最佳矫正视力<0.1为5只眼,0.1～0.3为9只眼,>0.3为16只眼,治疗前后视力比较差异有统计学意义(P<0.05)。术后视网膜24h内复位20只眼,72h内复位8只眼,再次手术3只眼。一次性手术成功率90%,二次成功率100%。发生巩膜外加压海绵外露1例。结论无放液、最小量巩膜外加压术是治疗单纯孔源性视网膜脱离的有效方法。

Objective To explore the efficiency and complications of minimal scleral buckling surgery without sub-retinal drainage for rhegmatogenous retinal detachment.Methods The clinical data of 28 patients（30 eyes） who received minimal scleral buckling surgery without sub-retinal drainage for their rhegmatogenous retinal detachment were retrospectively analyzed.Best corrected visual acuity（BCVA）,retinal attachment condition,and complications were observed before and after surgery.Results Among these 30 eyes,13 eyes were buckled by silicone sponge with only one scleral stitch,14 eyes with two scleral stitches,and 3 eyes with three or more stitches.The preoperative BVCA was0.1 in 14 eyes,0.1-0.3 in 8 eyes,and0.3 in 8 eyes.After（9.4±2.5） months of follow-up,the postoperative BVCA was0.1 in 5 eyes,0.1-0.3 in 9 eyes,and0.3 in 16 eyes（P0.05）.The retina was reattached by 24h for 20 eyes and by 72h for 8 eyes;three eyes were re-operated.The success rate was 90% for the first surgery and 100% after a second operation.Only one eye suffered from exposure of silicone sponge.Conclusion Minimal scleral buckling without subretinal drainage is an effective method to treat rhegamatogenous retinal detachment.