黄斑孔性视网膜脱离的手术效果观察

Surgical effect on retinal detachment due to macular hole

目的探讨黄斑孔性视网膜脱离不同手术方法的效果。方法回顾分析59例(59眼)黄斑孔性视网膜脱离的手术效果。分为3组,第1组,无明显的黄斑前膜或增生性病变者行巩膜缩短联合玻璃体腔注气(C3F8或消毒空气);第2组,有黄斑前膜或伴有增生性病变者行玻璃体切除联合C3F8填充术;第3组,黄斑孔为“白孔”者行玻璃体切除联合硅油填充术。结果第1组,巩膜缩短联合玻璃体腔注气28例中,15例黄斑孔闭合,视网膜复位,最高视力0.2;13例随访中黄斑孔再开,其中11例再行玻璃体切除联合C3F8填充或硅油填充。第2组,玻璃体切除联合C3F8填充术23例中,20例视网膜复位,最高视力0.3;2例再次手术后成功。第3组,玻璃体切除联合硅油填充术8例,在术后4～6月行硅油取出术,视网膜均复位,最高视力0.2。59例中最终手术成功56例(94.92%)。结论不同的术式对黄斑孔性视网膜脱离疗效不同。术前根据黄斑前膜形成与否及其程度,结合设备和技术条件选择合适的手术方法,可以取得较高的手术成功率。

Objective To evaluate the surgical effect on retinal detachment due to macular hole. Methods Fifty-nine cases （59 eyes） with macular hole retinal detachment were divided into 3 groups and reviewed after surgery. Group Ⅰ： 28 cases （28 eyes） performed scleral shortening and vitreous gas injection in the case of no contraction or proliferation of macular epiretinal membrane （ERM）. Group Ⅱ ： 23 cases （23） with contraction or proliferation of macular ERM performed pars plana vitrectomy （PPV） and vitreous gas filling （C3F8 or disinfectant air）. Group Ⅲ： 8 cases （8 eyes） with ＂white holes＂ performed PPV and silicone oil filling. Results Retina of 15 eyes was re-attached successfully after macular hole closed in group I with the best final visual acuity 0.2. Macular holes recurred in 13 cases, 11 eyes of which were performed PPV and C3 F8 filling or silicone oil vitreous infusion. Retina of 23 cases after PPV and C3 F8 filling were reattached with the best final visual acuity 0.3, 2 cases reoperated successfully. Eight cases with PPV and silicone oil filling were performed silicone oil removal and retinoprexy after 4 - 6 months and achieved 0.2 of the best final visual acuity. Finally, success was achieved in total 94.9% cases. Conclusions Surgical effect improved with different surgical methods choosing based on the feature of ERM and local condition of apparatus and technique.