急性视网膜坏死伴复杂性视网膜脱离的处理

Treatment of acute retinal necrosis with complicated retinal detachment

目的:分析急性视网膜坏死(acuteretinalnecrosis,ARN)所致视网膜脱离的临床特征,探讨玻璃体切除手术效果。方法:回顾性分析16例(16眼)因ARN所致复杂性视网膜脱离,5眼为巨大裂孔,9眼为周边多发网状裂孔,2眼视网膜表面见渗出和坏死灶。诊断明确后即予更昔洛韦200～400μg玻璃体腔内注射。患者均接受玻璃体切除手术。病程<2mo者8眼,首次术中5眼充填硅油,3眼充填长效气体。病程>2mo者8眼,首次术中7眼充填硅油,1眼充填长效气体。结果:术后追踪观察16～39mo。病程<2mo者手术成功率100%,10眼(94%)视力增进,6眼视力在0.05以上。病程>2mo者手术成功率88%,5眼(94%)视力增进,3眼视力在0.05以上。结论:ARN可致复杂性视网膜脱离,玻璃体切割加硅油充填术效果肯定,并存的视网膜脉络膜、视神经、血管病变及黄斑疤痕是限制视功能恢复的主要原因,因而早期诊断是提高手术成功率以及改善视力的关键。

AIM： To analyze the clinical characteristics of retinal detechment following the acute retinal necrosis （ARN）, and evaluate the effect of vitrectomy in the management of ARN. METHODS： Sixteen cases （16 eyes） of ARN with complicated retinal detachment had undertaken vitrectomy. Five eyes with giant hole, 9 eyes with multiple netlike holes peripherally, and 2 eyes with exudation and necrosis on the retina. When the diagnosis established, 200-4001J g Ganciclovir was injected into the vitreous cavity. During the first surgery, 5 eyes were tamponaded with silicone oil and 3 eyes with long-effect gas in eyes with course 〈 2 months. Seven eyes were tamponaded with silicone oil and 1 eye with long-effect gas in eyes with course 〉2 months. RESULTS： Followed up from 16 to 39 months. The rate of retinal attachment in eyes with course 〈 2 months was 100%, visual acuity increased in 10 eyes and 〉0.05 in 6 eyes. The rate of retinal attachment in eyes with course 〉2 months was 88%, visual acuity increased in 5 eyes and 〉 0.05 in 3 eyes. CONCLUSION： ARN may cause complicated retinal detachment. The vitrectomy and silicone oil tamponade seems an effective method for the acute retinal necrosis. The main reason restrict the visual acuity improvement is the concurrent pathology change of the retina, choroid, optic nerve, blood vessels and macular scar. Therefor, early diagnosis is the key for increasing success ratio and visual acuity.