外路手术治疗陈旧性裂孔性视网膜脱离

Scleral buckling surgery for long-standing rhegmatogenous retinal detachment

目的探讨外路手术治疗陈旧性裂孔性视网膜脱离的疗效，分析陈旧性裂孔性视网膜脱离的临床特点。方法陈旧性裂孔性视网膜脱离34例（34只眼），在双目间接检眼镜直视下行裂孔及变性区定位，在裂孔及变性区周围行视网膜冷凝后，根据情况分别采用巩膜表面加压术、环扎术或环扎加压术。术后定期观察视力、玻璃体及视网膜复位情况。结果①随访1～6个月，术后视网膜裂孔封闭，完全复位28只眼，再脱离6只眼，均发生在手术后1个月；其中2例手术后不足10d再脱离。②视力情况：视力提高28只眼，矫正视力〈0．3者18只眼，≥0．3者10只眼。③视网膜下液吸收情况：3d完全吸收19例，6d完全吸收7例，3～4周吸收2例。④冷凝反应：Ⅰ级10只眼，Ⅱ级14只眼，Ⅲ级4只眼。结论在双目间接检眼镜直视下，外路手术治疗陈旧性裂孔性视网膜脱离的手术效果良好，值得临床推广。手术后视网膜的复位和视力与病程有密切关系。陈旧性裂孔性视网膜脱离多是因为早期的误诊造成，应引起临床医生注意。

Objective To evaluate the therapeutic effect of scleral buckling surgery for long-standing rhegmatogenous retinal detachment（LRRD） under binocular indirect ophthalmoscope and the cfinical features of its. Methods 34 cases（34 eyes） were theLRRD. Its were performed the location of retinal breaks and mutational areas under binocular indirect ophthalmoscope, the retinal cryotheropy was involved around the retinal breaks and mutational areas. In accordance with specific conditions, the different cases were used respectively episcleral bucking, encircling or encircling and bucking.Visual acuity, vitreum and the condition of retinal redetachment were observed periodly after the surgery. Results①Follow up was one to six months. Retinal breaks of 28 cases were closed and got complete redtachment after operation.6 cases occurred once again retinal detachment in one month.②Visual acuity： The visual acuity was improved in 28 eyes. The correct visual acuity was lower than 0.3 in 18 eyes but better than 0.3 in 10 eyes.③Condition of subretinal fluid to be absorped： 19cases were completely absorped in 3 days, 7 cases were completely absorped in 6 days, 2 cases were completely absorped in 3-4 weeks. ④Cryotheropy reaction. I level in 10 eyes, 11 level in 14 eyes, and 111 level in 4 eyes. Conclusion The scleral buckling surgery for LRRD under binocular indirect ophthalmoscope has good surgical effort, it should be spreaded and practised. The retinal redtachment and visual acuity after operation are on intimate terms with time course of diease.The cause of LRRD occurring are maked an incorrect diagnosis by the clinical doctor, The clinical doctor should pay attention.