下直肌牵引巩膜外垫压不放液手术治疗上方孔源性视网膜脱离

The clinical study of preoperative traction of rectus and not drainage the subretinal fluid in rhegmatogenous retinal detachment

目的观察下直肌牵引及单纯巩膜外垫压不放液手术治疗上方孔源性视网膜脱离的临床效果。方法对上方孔源性视网膜脱离56例(56眼)术前进行下直肌缝线牵引制动,采用视网膜裂孔冷凝、巩膜环扎、外垫压及术中不放液的手术方法,对治疗结果进行分析。结果56例(56眼)经下直肌牵引制动3～5天后,52眼(92.86%)的视网膜脱离特别是上方球形脱离有明显消退,视网膜下液均有消散,其中28眼(50.00%)完全复位。53眼(94.64%)均行不放液术达到准确封闭孔源的目的。出院前治愈率为96.43%,未愈3.57%。结论下直肌缝线牵引制动可促进视网膜下液消退、平复,有利于术中裂孔准确定位、扣压位置适当,从而有效封闭裂孔。扩大了不放液手术适应范围,提高不放液手术成功率。

Objective To observe the effect of pre-operative traction of rectus and cryotherapy and scleral encircling or scleral bucking without drainage the subretinal fluid in rhegmatogenous retinal detachment. Methods 56 patients （56 eyes） with superior retinal detachment were treated by preoperative bed rest and immobilization of the affected eye using a temporary inferior rectus suture taped to the brow, and succedent scleral encircling or scleral bucking-without drainage the subretinal fluid were used in each case. Results The subretinal fluid of 28 eyes （50%） were absorbted completely＇after bed rest and rectus suture fixation for 3-5 days. Sufficient pre-operative flattening of the retina was achieved in 52 eyes （92. 8% ） to permit successful simple detachment surgery, with drainage of subretinal fluid in only 3 eyes. 54 eyes （96.4%） were cured. Conclusion The operation without drainage of SRF （subretinal fluid） can keep relative stability in intraocular fluid and pressure, with wide indications and less complications. Temporary inferior rectus suture can provide sufficient pre-operative flattening of retinal, and improve success rate of surgery.