视网膜脱离术后巩膜嵴前坡裂孔再次引起视网膜脱离的治疗

The management of recurrent retinal detachment with on-buckle holes

目的探讨孔源性视网膜脱离行巩膜扣带术后,位于巩膜嵴前坡的裂孔再次引起视网膜脱离的治疗方法。方法观察16例孔源性视网膜脱离患者,行巩膜扣带术后,裂孔位于巩膜嵴前坡,但仍有视网膜脱离。其中3例患者视网膜脱离局限于嵴前坡,观察脱离程度变化,于术后4～6个月因脱离加重行放水冷凝术。另13例术后视网膜全脱离。其中3例因严重增殖性玻璃体视网膜病变(PVR)行玻切加激光封闭裂孔治疗;另10例行双眼包扎,促吸收药物治疗,其中3例网膜下液完全吸收行激光封闭裂孔;7例网膜下液部分吸收,视网膜脱离局限于巩膜嵴前坡,行放水冷凝术。结果16例患者术后视网膜全部复位,裂孔完全封闭,随访1～3年均无复发。结论孔源性视网膜脱离行巩膜扣带术后,位于巩膜嵴前坡的裂孔引起的视网膜脱离,应依据眼内情况决定手术时机与方式。如果PVR严重应行玻切术。如果PVR在C1级以下应先行保守治疗,视网膜下液吸收后可行激光治疗。局限于嵴前坡的持续脱离行单纯放水冷凝术可使视网膜复位。手术应遵循视网膜脱离最小量手术治疗的原则。

Objective To find the methods to manage thc recurrcnt retinal dctachment with brcaks on buckled sclera after regular scleral buckling surgery. Methods Sixteen cases presented retinal re-detachment after regular scleral buckling surgery with breaks on buckled sclera. Three cases with dctachment localized to buckled sclera were observed. After 4 - 6months, these cases received subretinal fluid drainage combine with cryothcrapy for thc progrcssion of the detachment. For another 13 cases with total retinal detachment ,3 cases developed severe PVR and underwent vitrectomy combine with laser photocoagulation; Another 10 cases received bilateral patching to fasten the sub-retinal fluid absorption ,3 of them undergone laser photocoagulation after the fluid totally absorbed; 7 of them with partial fluid absorption but thc retinal detachment were localized around the buckle, underwent sub-retinal fluid drainage combine with. Results Retinal re-attachment was achieved in all of the 16 cases, the breaks were totally sealed. There is no recurrent case after 1-3 years follow-up. Conclusions When and how to manage the recurrent retinal detachment with on-buckle holes after scleral buckling surgery, depends on intra-ocular conditions. Vitrectomy is needed if severe PVR presented. If the PVR is less than C1, observation and laser photocoagulation after the sub-retinal fluid absorption should be applied. A simple sub-retinal fluid drainage and cryotherapy could be effective to re-attachment if the sub-retinal fluid is persistent and localized around the buckle.