马蹄形裂孔视网膜脱离手术方式的选择

Selection of the operation methods for retinal detachment caused by horse shoe shaped tear

目的 探讨马蹄形裂孔视网膜脱离在不同粘连牵拉状况下手术方式的选择。方法 回顾性地研究马蹄形裂孔视网膜脱离患者共 3 2 1例 (3 2 1眼 ) ,根据选用的术式分为巩膜外加压术和玻璃体手术两组 ,各组分别统计裂孔的大小、位置关系以及局部玻璃体视网膜粘连牵拉的程度 ,并分别对两种术式的效果进行比较性研究 ,分析上列因素对手术效果的影响。结果 (1)实施巩膜外加压手术 2 11例 ,其中 181例视网膜复位 ,成功率为 85 78% ;实施玻璃体视网膜手术 110例 ,其中 93例视网膜复位 ,成功率为 84 60 %。 (2 )在巩膜外加压术中 ,裂孔的范围 >2PD、多个象限分布以及裂孔部位玻璃体与视网膜粘连牵拉张力大者 ,其成功率分别为 61 2 9%、 62 5 0 %和 5 8 62 % ;在玻璃体手术组中其成功率则分别为 82 81%、 86 67%和 90 2 %。两组间差异非常显著 (P <0 0 1)。结论 马蹄形裂孔部位视网膜玻璃体粘连牵拉张力大 ,裂孔位于多个象限 ,其大小超过 2PD者应选择玻璃体手术。

Objective To study the selection of operation methods for retinal detachment(RD)caused by horse-shoe shaped tear under various vitreo-retinal traction.Methods 321 cases(321 eyes)of RD caused by horse-shoe shaped tear were retrospectively studied.Two groups were divided based on the different operation methods:scleral buckling group and vitrectomy group.The statistic was made for the area of the tear,the location of the tear,as well as the degree of the vitreo-retinal traction of the tear in each group respectively.The operation effects by two kinds of operation methods were compared,and the influence of the above mentioned factors on operation effects were analyzed.Results (1)211 cases were operated with scleral buckling,in which 181 cases achieved retinal re-attachment.The success rate was 85 78%.110 cases were operated with vitrectomy,in which 93 cases achieved retinal re-attachment.The success rate was 84 60%.(2)For the tear of its area more than 2PD,located in multi quadrants and with stronger tensile force of vitreous-retinal traction,the operation success rate in scleral buckling group were 61 29%、62 50% and 58 62%,while in vitrectomy group,the operation success rate were 82 81%、86 67% and 90 2% respectively.The difference between two groups was very remarkable( P <0 01).Conclusions For the horse-shoe shaped tear which its area more than 2PD,located in multi quadrants and with stronger tensile force of vitreous-retinal traction,the vitrectomy should be selected.