对侧眼无症状视网膜裂孔预防性激光光凝术后失败原因分析

Clinical study of failure of asymptomatic retinal breaks prophylactic retinopexy in fellow eyes

目的探讨孔源性视网膜脱离患者的对侧眼无症状视网膜新裂孔行预防性激光光凝术后发生视网膜裂孔或视网膜脱离的原因。方法对21例孔源性视网膜脱离同时行对侧眼无症状视网膜裂孔预防性激光光凝术后发生视网膜裂孔或视网膜脱离的患者,记录其年龄、性别、屈光状态、晶状体状态、对侧眼预防性治疗的病变类型和治疗的方法、预防性激光光凝术到视网膜裂孔或视网膜脱离形成的时间和玻璃体状态、新发生裂孔的类型和位置、治疗的方法。结果平均年龄41.3岁,15例(71.4%)为男性,全部为近视眼,其中16例(76.2%)高度近视(大于6.0D),全部为有透明晶状体眼,对侧眼预防性治疗的病变类型:15例(71.4%)为变性萎缩孔,6例(28.6%)为马蹄孔伴随广泛视网膜格子样变性(变性区大于6个钟点),全部病例均行视网膜裂孔孔周氩激光光凝术,视网膜裂孔或视网膜脱离形成的时间平均为21.6个月,术前部分玻璃体后脱离(PVD)2例(9.5%),无明显的色素颗粒,新裂孔或视网膜脱离形成后,部分PVD伴色素颗粒18例(85.7%),全部均为马蹄形裂孔,马蹄孔伴后缘卷边2例(9.5%),9例(42.8%)新裂孔形成的位置位于激光光凝区的边缘,12例(57.2%)位于正常或未治疗的视网膜上,发展为视网膜脱离18例(85.7%),累及黄斑6例(28.6%),16例行视网膜裂孔冷凝联合巩膜环扎和外加压术,2例行玻璃体切除联合惰性气体填充术;单纯视网膜裂孔3例(14.3%),再次行氩激光光凝术,术后平均随访6个月。结论中青年高度近视不伴随PVD是对侧眼无症状视网膜裂孔光凝术后发生视网膜裂孔或视网膜脱离的高危因素;预防性激光治疗与玻璃体后脱离牵拉新裂孔形成有密切相关。

Objective To investigate the clinical symptom of failure of asymptomatic retinal breaks retinal prophylaxis in fellow eyes of patients with rhegmatogenous retinal detachment. Methods Records were reviewed for 21 patients who had retinal breaks or detachment subsequent to prophylactic retinopexy applied to the fellow eye at the time of primary rhegmatogenous retinal detachment surgery, which included age, sex, refractive error, lens status, the type of prophylactic treatment of the fellow eye, the time interval between prophylactic treatment and retinal break or detachment formation, the status of the vitreous, and the site and type of subsequent retinal breaks. Results Of the 21 patients, 15 were male （mean age, 41.9 years）. All of patients were myopia and transparent phakie eye, Sixteen （76.2%） were high myopia, the type of prophylactic treatment of the fellow eye included 15 （71.4 % ） degenerative atrophy holes, 6（28.6% ） horse tears with extensive lattice degeneration （ 〉 6 clock hours）. All of patients were treated with laser retinopexy, the time interval between prophylactic treatment and retinal break or detachment formation was 21.6 mean months, 2 （9.5%） with partial PVD before treatment, 18 （ 85.7% ） with partial PVD after treatment . All were horse tears after treatment , of which 2 with hinder margin joggling, developed retinal tears related to acute posterior vitreous detachment, of which 9 （42.8%） were at the edge of retinopexy and 12 （57.2%） were in the normal or untreated retina. 18 （85.7%） developed a retinal detachment, of which 6（28.6% ） involve the fovea. Subsequent treatment included eryotherapeutie and laser retinopexy, seleral buelding, and vitreetomy. Conclusion Youth with high myopia without PVD was the high risk factor of failure of retinal prophylaxis in fellow eyes of patients with rhegmatogenous retinal detaehment. Prophylactic laser retinopexy correlated to retinal tears related to acute posterior vitreous detachment.