视网膜脱离外路显微手术中色素颗粒进入玻璃体临床观察

Clinical observation of intravitreal dispersion of retinal pigment epithelium cells during external approach microsurgery of retinal detachment

目的观察在视网膜脱离外路显微手术中做视网膜裂孔冷凝或定位时，色素颗粒从裂孔播散入玻璃体腔，对手术效果的影响。方法回顾性统计分析视网膜脱离外路显微手术中有色素颗粒从裂孔涌入玻璃体腔的连续38例39只眼，均是初发裂孔性视网膜脱离患者，PVR分级为B级以下。平均每只眼裂孔数2．67个。单纯硅压11只眼，硅胶填压联合环扎28只眼。结果随访至少6个月以上，涌入玻璃体腔内的色素颗粒逐渐减少或消失。一次手术后视网膜脱离复位38只眼（96．7％），1只眼出现新的视网膜裂孔，经玻璃体手术后视网膜复位，最终视网膜脱离复位率为100％。无过度冷凝视网膜表现，没有发生严重PVR病例。结论视网膜脱离外路显微手术中色素细胞播散进入玻璃体腔不会引起PVR发生或加重，只要裂孔被有效封闭，手术效果良好。

Objective It is a common phenomenon that a lot of pigmented debris disperses into vitreous cavity through retinal breaks during the cryotherapy or location of retinal breaks while the external approach microsurgery for rhegmatogenous retinal detachment （RRD） is performed. The study was designed for observing the surgical outcomes of this complication. Methods A consecutive thirty-eight patients （39eyes） with RRD, which were found intravitreal dispersion of retinal pigment epithelium cells during external approach microsurgery of retinal detachment, were retrospectively analyzed. All of them were primary RRD and proliferative vitreoretinopathy （PVR） was classified equal to or under B. The numbers of average retinal breaks were 2.67. The size of the retinal break ranged from 1/7DD to 1.5 clock hour. The scleral buckling was performed in 11 eyes, and the circling and buckling in 28 eyes. Results The following-up times were 6 months at least. The retinal pigment epithelium ceils of intravitreal dispersion gradually decreased and faded away. Retinal reattachment was achieved in 38 eyes （96.7%） after the primary surgery. A new retinal break was formed in one case and caused retinal redetachment. After vitreous surgery, this case got retinal reattachment. The final rate of reattachment was 100%. The excessive cryotherapy and severe PVR were not occurred. Conclusion As long as the holes or tears are closed effectively, the intravitreal dispersion of retinal pigment epithelium cells during external approach microsurgery of retinal detachment doesn＇t cause PVR develop or aggravate. The surgical outcomes are excellent..