孔源性视网膜脱离再手术病例的临床分析

Clinical analysis of reoperation of rhegmatogenous retinal detachment

目的:分析孔源性视网膜脱离手术失败及术后脱离复发病例的原因、再手术术式选择及手术效果。方法:回顾性分析59例(60只眼)巩膜扣带术后视网膜未复位或脱离复发行再次手术治疗的孔源性网膜脱离病例。结果:第2次手术与第1次手术后出院视力相比差别无统计学意义(P>0.05)。第2次手术前增生性玻璃体视网膜病变(PVR)程度比第1次明显加重(P<0.05)。手术失败及早期视网膜脱离复发原因主要为PVR加重、新裂孔形成、原裂孔闭合不良。晚期复发原因可能为玻璃体基底部的牵拉。结论:视网膜脱离手术成功的关键是术前全面细致检查,术中确切封闭裂孔。巩膜扣带术仍然是再手术的主要术式。PVR严重时应行玻璃体切割术。绝大多数患者经再手术治疗后视网膜复位。

Objective To explore the causes, method selection and effects of reoperation about failed operation and recurrence of rhegmatogenous retinal detachment. Method We analyzed 59 cases （60 eyes） of RRD retrospectively, whose retina couldn＇t be retached or redetached after episcleral buckling surgery, and needed reoperation. Results The visual acuity showed no sigmficant differences after first and second surgery（P〉0.05）, and the grades of proliferative vitreoretinopathy （PVR） before second surgery were significantly severer than that of first surgery （P〈0.05）. The reasons that caused failed operation and early recurrent retinal detachment of RRD were progressive vitreoretinal traction with PVR, formation of new retinal breaks, reopening of original breaks, and the reasons that lead to later recurrent retinal redetachment were the vitreoretinal traction of vitreous bases. Conclusion The key to operative success are. searching ocular fundus carefully before operation and buckling all of the retinal breaks during operation. Episcleral buckling surgery is also the main method of reoperation. Vitrectomy should be applied when PVR is seriously. The majority of patients＇ retina could be retached after reoperation.