首选玻璃体切除术治疗简单孔源性视网膜脱离的临床观察

The clinical study of primary pars plana vitrectomy for simple forms rhegmatogenous retinal detachment

目的回顾总结首选玻璃体切割术治疗简单裂孔源性视网膜脱离的临床疗效。方法选择26例（26只眼）简单裂孔源性视网膜脱离，裂孔均位于上方，增生性玻璃体视网膜病变（PVR）C1级或以下。均采用标准闭合式玻璃体切割术，巩膜外冷凝裂孔，眼内注入C3F8填充，均无外加压。随访2—16个月，平均9个月，记录视网膜复位情况、末次最佳矫正视力及并发症。结果全部病例均一次复位成功（复位率100％），末次最佳矫正视力均有不同程度的提高，在0．2～0．3者9只眼（34．6％），0．3～1．0者17只眼（65．4％），视网膜裂孔冷凝不足8只眼（30．8％），补充激光光凝，1只眼（3．8％）术后1个月出现后囊下型白内障，12只眼（46．2％）一过性高眼压，经局部使用降眼压药物，1周后眼压正常，未出现其它并发症。结论在经济条件允许时，对于上方裂孔的简单孔源性视网膜脱离．可采用玻璃体切割术作为首选方式。

Objective To evaluate the clinical results of primary pars plana vitrectomy as the first treatment methotis for simple forms rhegmatogenous retinal detachment. Methods In this prospective consecutive clinical trial, 26 eyes of 26 patients with superior retinal break and proliferative vitreoretinopathy（ PVR）stage C1 or less were enrolled. Patients underwent pars plana vitrectomy with cry otherapy and C3F8 tamponade. All patients were followed from 2 to 16 months with an average follow-up of 9 months. Reattachment of the retina and best corrected visual acuity （ BCVA ）and complications were recorded. Results Reattachment was achieved in all eyes （ 100%） with a single operation. Final BCVA was improved. VA was 0.2 to 0.3 in 9 eyes （ 34.6% ） and 0.3 to 1.0 in 17 eyes（ 65.4% ）. Insufficient cryotherapy were found postoperatively in 8 eyes（30.8% ）. These retinal breaks were treated with photocoagulation. One patient（3.8% ） had posterior subcapsular opacity at the 1-month postoperative visit. 12 eyes （ 46.2% ） were present with higher intraocular pressure and recovered after 1 week. Conclusion The primary vitrectomy as the first option for simple rhegmatogenous retinal detachment with superior break can be applied to the patient with enough economic support.