57例经玻璃体手术治疗的渗出性视网膜脱离临床分析

57 cases of exudative retinal detachment treated with vitrectomy

目的总结玻璃体手术治疗的渗出性视网膜脱离患者的病因、手术指征及术后效果。设计回顾性病例系列。研究对象57例经玻璃体手术治疗的渗出性视网膜脱离患者。方法回顾性分析相应的临床资料。主要指标病因、手术指征及术后效果。结果57例(62眼)渗出性视网膜脱离中Coats病23例(45.2%),为引起渗出性视网膜脱离的主要病因;其次为家族性渗出性玻璃体视网膜病变8例(12.9%)、葡萄膜炎7例(11.3%)、视网膜血管瘤7例(11.3%)、泡性视网膜脱离6例(9.7%)、眼内炎4例(6.5%)和视乳头小凹2例(3.2%)。严重的渗出性视网膜脱离及并发增生性病变是进行玻璃体手术的指征。术后短期大部分患者可获有用视力;随访6个月以上者64.9%,渗出性视网膜脱离复发率为5.4%,大部分患者仍能保留有用的视力。结论Coats病是引起渗出性视网膜脱离中需要采取玻璃体手术治疗的最主要原因。当渗出性视网膜脱离引起增生性病变、玻璃体积血或病变累及黄斑时是采取玻璃体手术的主要指征。手术可使大部分患者获得有用视力。(眼科,2008,17:52-55)

Objective To review the causes of exudative retinal detachment （ERD）, indications of vitrectomy for ERD and its outcomes. Design Retrospective case series. Participants 57 patients with ERD received vitrectomy in EENT Hospital, Fudan University. Methods A retrospective analysis of clinical records were conducted. Main Outcome Measures Etiology, vitrectomy indications and its outcomes. Results 57 cases （62 eyes） with ERD received vitrectomy. The disease distribution of vitrectomy were Coats disease in 23 cases （45.2%）, familial exudative vitreoretinopathy in 8 cases （12.9%）, uveitis in 7 cases （11.3%）, retinal hemangioma in 7 cases （11.3%）, bullous retinal detachment in 6 cases （9.7%）, endophthalmitis in 4 cases （6.5%） and pit of optic nerve in 2 cases （3.2%）. Severe ERD and proliferative change were major indication for treatment with vitrectomy. During follow-up period, most patients gained useful vision in early stage. Follow up rate of 6 months or more was 64.9%. The recurrence of ERD was 5.4% and most patients also gained useful vision. Conclusion Coats disease is the prominent cause of being treated with vitrectomy in ERD. When proliferation or vitreous hemorrhage happens or macula is involved, vitrectomy should be performed. Most patients can gain useful vision after vitrectomy.