玻璃体切割术治疗视网膜脱离合并脉络膜脱离

Primary Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

目的探讨玻璃体切割术治疗视网膜脱离合并脉络膜脱离的临床疗效及适应证。方法对23例(23眼)视网膜脱离合并脉络膜脱离的患者,术前7 d 即开始口服强的松,采用标准平坦部三切口玻璃体切割及眼内填充(C_3F_8或硅油),酌情联合巩膜扣带术,术后随访6～12个月。结果术中新发现裂孔5个(21.74%);术后6个月,视网膜完全复位20眼(86.96%),部分复位2眼(8.70%),未复位1眼(4.35%);术后视力有不同程度的提高,其中0.1以上为5眼(21.74%);术后并发症较少,增生性玻璃体视网膜病变(proliferativevitreore tinopathy,PVR)的发生率较低。结论对眼内增殖明显,视网膜裂孔位于大范围脉络膜脱离区或术前未发现裂孔的视网膜脱离合并脉络膜脱离,玻璃体切割术是可以优先考虑的术式。

Purpose To evaluate the clinical effects of primary pars plana vitrectomy（PPV） in management cases with rhegrnatogenous retinal detachment （RRD） associated with choroidal detachment （ChD）.Methods Twenty-three consecutive patients （23 eyes） received routinely oral predinisone for 7 days preoperatively. Standard vitreetomy were performed on all patients, concomitance with scleral buckling if needed, postoperative tamponade was done by C3F8 or silicone oil. Patients were followed up for 6 to 12 months. Results Five missed breaks （21.74%） were identified intraoperatively. Six months after operation,20 eyes were completely attached,2 eyes partially attaehed, 1 eye unattached. The visual acuity improved in most eyes, in 5 eyes（21.74% ） was more than 0.1. The complications of primary, vitrectomy were relatively rare, whereas PVR seldom occurred among the cases. Conclusion Primary vitrectomy for rhegmatogenous retinal detachment and choroidal detachment is an effective and optimal procedttre especially for those with obvious PVR and retinal breaks located in broad choroidal detachment area or no detected retinal breaks.