孔源性视网膜脱离合并非继发性青光眼治疗的初步探讨

Treatment of patients with rhegmatogenous retina detachment combined with non-secondary glaucoma

目的:探讨孔源性视网膜脱离合并非继发性青光眼的发病原因、治疗方法及疗效。方法:回顾性分析28例孔源性视网膜脱离合并原发性或先天性青光眼患者的临床资料。结果:视网膜复位手术28例,一次性成功者25例(89.3%),失败3例(均为行外加压手术者);术后第1天眼压为10～46(28.1±6.5)mmHg,术后1周眼压为(18.9±7.2)mmHg,最后复诊时眼压为(17.6±6.2)mmHg;再行抗青光眼手术者10例(35.7%);术后脉络膜出血2例,渗出性脉络膜脱离2例。结论:此类病人开角型青光眼比例较高,外伤及手术是重要原因;手术治疗成功率与普通孔源性视网膜脱离无明显差异;提倡玻璃体切割+硅油填充或放液+注气+冷冻+加压(DACE)的手术方法;脉络膜易受累,即术前脉络膜脱离,术后脉络膜出血及渗出较易发生;术中术后应密切注意眼压;术后视力恢复较差,可能与原发青光眼/眼压有关。

Objective To discuss the cause of disease, treatment and therapeutic effect in patients with rhegmatogenous retina detachment （RRD） combined with non-secondary glaucoma. Methods Clinical data of 28 patients with RRD combined with primary or congenital glaucoma were retrospectively analyzed. Results Twenty-five out of the 28 patients succeeded with one operation （89.3%）. The intraocular pressure of post-operation ：on the 1 st day was 10 - 46 （28. 1±6.5 ） mmHg, on the 7th day was （18. 9 ±7. 2） mmHg, and on the last re-examination day was （ 17.6±6.2） mmHg. Anti-glaucoma operation was performed in 10 patients after the retinal operation. Chroidal hemorrhage was found in 2 patients and 2 chroidal exudations were found after the retinal operation. Conclusion The proportion of primary open angle glaucoma is higher, than that of primary angle closure glaucoma, and trauma or surgery before the retinal operation is an important cause in glaucoma patients with RRD. There is no obvious difference in the ratio of surgical success between non-secondary glucauma with RRD and those RRD patients without glaucoma. Vitreotomy ＋ silicon oil injection or drainage of subretinal fluid ＋ air injection ＋ cryocoagulation ＋ explants is recommended. Chriod is easily involved. It is important to control the intraocular pressure during and after the surgery. The final visual acuity is rather poor, which may be related to the glaucoma and intraocular pressure.