裂孔源性视网膜脱离的最小量巩膜外加压手术

Minimal scleral buckling for primary retinal detachment

目的探讨裂孔源性(原发性)视网膜脱离巩膜外加压手术的最小量手术方式及其效果。方法裂孔源性视网膜脱离26例(26眼),在手术显微镜下行球结膜环形剪开、四直肌预置牵引线,在间接检眼镜下行视网膜裂孔精确定位及中度冷凝,手术显微镜下行巩膜外放液及巩膜缝线固定外加压块,所有外加压均采用修剪后的小硅胶海绵块,只固定巩膜褥式缝线1对。多发性裂孔于每个裂孔处分别于巩膜表面以1对褥式缝线固定硅胶海绵。所有手术眼均未行环扎术。手术后随访3～9月。结果所有患者手术过程顺利,无术中并发症,手术损伤小;手术后眼底检查外加压精确地顶压裂孔,视网膜完全复位25眼,1眼高度近视于手术后2周视网膜脱离复发经玻璃体手术后视网膜复位;手术后视力提高者21眼,不变4眼,下降1眼。结论最小量的外加压手术的优点是精确、可靠、创伤小,能避免传统巩膜扣带手术的一些并发症,手术成功率高。

Objective To study the effect of the minimal seleral buckling for primary retinal detachment. Methods 26 eyes with rhegmatogenous retinal detachment were enrolled in the study. Microsurgery was used in some parts of scleral buckling. The entire fundus was examined by indirect ophthalmoscopy. The position of each retinal break was marked externally on the sclera. Cryotherapy was applied. A thin and little silicone rubber sponge was placed episeleral by one pair of suture to create a seleral buckle. Multiple retinal breaks in different quadrants were supported by separate scleral buckle. The seleral encircling was used in no eyes. All patients were followed up for 3 - 9 months. Results All retinal breaks were supported on the seleral buckle. In 26 eyes, 25 eyes got complete retinal reattachment. The visual acuity improved in 21 eyes. Conclusions The minimal scleral buckling for primary retinal detachment can reduce the complications of conventional seleral buckling and maintain a high success rate.