玻璃体视网膜手术治疗晚期大泡状视网膜脱离的临床疗效观察

Therapeutic effects of vitrectomy on terminal bullous retinal detachment

目的观察玻璃体视网膜手术治疗晚期大泡状视网膜脱离的疗效。方法回顾分析经裂隙灯显微镜、三面镜及间接检眼镜、B型超声以及荧光素眼底血管造影检查确诊，无法进行有效激光光凝而行玻璃体视网膜手术治疗的晚期大泡状视网膜脱离患者7例9只眼的临床资料。所有患眼均在局部麻醉下巩膜穿刺放出视网膜下液后，行睫状体扁平部的闭合式三切口玻璃体切割手术。去除玻璃体及后皮质．视网膜内引流，吸出视网膜下液体，激光光凝封闭视网膜切开处和渗出区，气液交换后注入眼内填充物。手术后随访3个月～8年，平均随访时间47个月。结果随访期内视网膜均复位。1只眼在手术后2年复查时因视网膜前增生膜牵引形成一裂孔，并有一硅油泡进入视网膜下造成局部视网膜脱离而行第二次手术治疗．手术后随访1年视网膜平复。8只眼手术后视力较手术前有不同程度提高，1只眼手术后视力无改变。结论晚期严重夫泡状视网膜脱离患者行玻璃体视网膜手术治疗能安全有效地促进视网膜复位，挽救患眼的部分视力。

Objective To evaluate the therapeutic effect of vitrectomy on bullous retinal detachment. Methods The clinical data of 7 patients （9 eyes） with bullous retinal detachment who had undergone vitrectomy due to useless photocoagulation were retrospectively analyzed. Bullous retinal detachment of the patients had been diagnosed by examination of slit-lamp microscope, three-mirror gonioscope, indirect ophthalmoscope, B-mode ultrasound, and fundus fluorescein angiography. All of the affected eyes underwent vitrectomy with closed triple incisions through the pars plana after release of subretinal liquid under the local anaesthesia. The cortex of vitreous body was taken out, and exsuction of subretinal liquid was carried out via retinal incision. Photocoagulation closed the incision and the effusion area of the retina, and intraocular filling matter was injected after exchange of air and liquid. The followup period lasted 3 months to 8 years with the average period of 47 months. Results Reattached retina was found in all of the affected eyes during the follow-up period. One eye underwent a second vitrectomy due to local retinal redetachment caused by a new retinal hole formed by the pull of pre-retinal proliferative membrane and a silicon vesicle entered the subretinal space, but the retina reattached after 1-year followup examination. The visual acuity improved in different degree after the operation in 8eyes, but remained unchanged in 1 eye. Conclusion Vitrectomy for terminal bullous retinal detachment may promote the reattachment of retina safely and effectively, and save partial visual acuity of the affected eyes.