全视野镜下玻璃体手术治疗巨大裂孔性视网膜脱离

Application of wide angle vitreoretinal viewing system in vitrectomy for retinal detachment with giant retinal tear

目的探讨全视野镜下玻璃体手术治疗巨大裂孔性视网膜脱离的手术方法及效果。方法对2002-08～2004-12行玻璃体手术的34例巨大裂孔性视网膜脱离患者34只眼作回顾性分析。其中90°-180°裂孔12例,180°以上裂孔者22例。手术方法包括经平坦部玻璃体切除,剥除增生膜,松解牵引,全氟化碳液体展平视网膜,眼内激光光凝,全氟化碳液体-硅油置换。所有手术操作均在130°全视野镜下进行。结果34例巨大裂孔性视网膜脱离在术中均完全解剖复位,2例术后1-2个月复发增生性玻璃体视网膜病变,所有病例术后36个月取出硅油,32例视网膜完全复位,2例在取油时行增生膜剥除,1例再次填充硅油,1例填充惰性气体C3F8。随访6-12个月,复位的32例中有1例复发视网膜脱离,再次手术后填充硅油。结论全视野镜能简化手术操作,减少并发症的产生,有效提高巨大裂孔性视网膜脱离的手术复位率。

Objective To explore the effect of vitrectomy on giant rehgmatorgenous retinal detachment by using reinverting operating system. Methods All 34 patients （34 eyes） with giant rehgmatorgenous retinal detachment were analyzed retrospectively, in which 12 cases had retinal tear between 90° and 180°, 22 cases more than 180°. All surgical procedures were performed under wide angle vitreoretinal viewing system, including pars plana vitrectomy, membrane peeling, traction relaxing, retinal reattachment by perfluorocarbon liquid, endolaser, perfluorocarbon-licone oil exchange. Results Surgical reattachment was attained in all eyes. Proliferative vitreoretinopathy occurred in 2 cases at 1 - 2 months after operation. Silicone oil was removed at 3 - 6 months after operation in all cases, of which 2 cases were performed membrane peeling during the surgery, i case was implanted with silicone oil tamponade and 1 with C3F8 gas tamponade. The average follow-up was 6 - 12 months. Of 32 successful cases, 1 case redetached. Conclusion Application of wide angle vitreoretinal viewing system can simplify the surgical procedure, reduce the complication and increase the reattachment rate.