外伤性出血性视网膜脱离的手术疗效分析

Clinical effect of hemorrhagic retinal detachment due to trauma

目的 探讨外伤性出血性视网膜脱离的手术方法及疗效.方法 24例（24眼）外伤性出血性视网膜脱离行玻璃体视网膜手术,14例行120°～180°周边视网膜切开除血,4例辅助运用组织纤溶酶激活剂（tPA）视网膜下注射,6例行小孔状视网膜切开除血.结果 术后视网膜解剖复位24例,复位率100.00%,术后视力20例不同程度提高,4例无改变;随访3～12月（平均6月）解剖复位20例,复位率83.33%.18例视力不同程度提高（75.00%）,6例视力无改变.结论 对外伤性出血性视网膜脱离应用玻璃体手术联合视网膜切开及切除术、tPA的辅助运用是有效的手术方法.

Objective To investigate the method and effect of surgery for the hemorrhagic retinal detachment due to trauma （THRD）. Methods 24 cases of THRD were treated with vitrectomy, in which 14 eyes were treated with 120-180° peripheral retinotomy, 6 cases with small retinotomy, 4 cases with subretinal tPA injection. Results Retinal attachment were obtained in all of the operated eyes at the end of the operation, visual acuity was improved in 20 cases （83.3%） , unchanged in 4 cases. After being followed up for 3 to 12 months （mean 6 months） ,20 cases （83.3%） achieved retinal reattachment. Visual acuity was improved in 18 cases（75% ） , unchanged in 6 cases. Conclusions As the large size of the subretinal hemorrhage and other complications of trauma （ e. g, vitreous hemorrhage, infection, intraocular foreign body, choroidal detachment）,the THRD makes the treatment more complex, but vitrectomy combined with retinotomy and subretinal tPA injection may be an effective remedy for the THRD.