显微镜直视下视网膜脱离术

The surgery of retinal detachment under surgical microscope

目的探讨显微镜直视下视网膜脱离手术的可能性。方法对裂孔性视网膜脱离患者36例36只眼,预置硅胶块和/或环扎带后,在手术显微镜直视下经巩膜电凝排出视网膜下液、视网膜冷凝、最后顶起硅胶填压块检查裂孔是否封闭。术后观察视力恢复及网膜复位情况。结果视网膜完全复位35眼,再次外路手术复位1眼。视力提高32眼,不变2眼,下降2眼,矫正视力在0.3以上33眼。除电凝外排液穿透视网膜和引起视网膜下出血1例外,其它病例排液顺利。所有病例在显微镜直视下冷凝反应均清晰可见,并且轻度屈光间质混浊不影响观察冷凝反应和裂孔定位。结论显微镜下行视网膜脱离手术具有简单、方便、清晰、可靠等优点。

Objective To evaluate the possibility and the outcome of the retinal detachment surgery under surgical microscope. Methods Thiry-six consecutive cases of thegmatogenous retinal detachment were en-rolled in this study.All received retinal detachment surgery under microscope. First,buckling and/or circling were performed, and then under surgical microscope the drainage of subretinal fluid with diathermy electric coagulation and retinal cryopexy through sclera were performed.Then the location of the retinal breaks was examined under microscope by indentation of silicone buckling..After the surgeries,all the patients were fol- lowed up.Visual acuity,intraocular reactions and the condition of retinal reattachment were observed each time. Results Thiry-five cases got complete retinal reattachment.One eye got reattachment after an additional scleral buckling. The visual acuity was improved in 32 eyes,the same as that of preoperation in 2 eye,and lowered in 2 eyes.The best-corrected visual acuity was better than 0.3 in 33eyes.Extemal drainage of subretinal fluid was successful in 35 eyes,except 1 cases of subretinal hemorrhage.The reaction of retinal cryotherapy was seen clearly under the microscope, and the observation of cryotherapy and the location of retinal breaks were not affected by mild-media opacities. Conclusions it appeared to be simple,convenient,easy observable to perform retinal reattachment surgery under microscope,and the outcome is reliable and satisfactory.