晚期急性视网膜坏死玻璃体切割术疗效分析

The curative effect ofvitrectomy for later stage acute retinal necrosis

目的探讨玻璃体切割术联合巩膜扣带、眼内填充硅油或惰性气体（C2F6），对晚期急性视网膜坏死所致的裂孔源性视网膜脱离的疗效。方法回顾性分析10例（10只眼）晚期急性视网膜坏死合并视网膜脱离患者的临床资料，包括临床表现、辅助检查及治疗过程。随访2～32个月，平均（15．20±10．84）月。结果至随访结束，8只眼视网膜复位，1只眼部分复位，1只眼视网膜脱离复发。9只硅油填充眼中6只行硅油取出，其中5只眼视网膜复位，1只眼视网膜脱离再发。视力情况：8只眼提高，1只眼无变化，1只眼减退。2只眼术后发生低眼压。结论晚期急性视网膜坏死所致的视网膜脱离，通过玻璃体切割手术联合硅油或惰性气体填充视网膜复位率较高，可获得较满意的视力。为预防低眼压发生。建议在行大面积视网膜切开切除的病人中，若无并发症的发生，硅油可暂不取出，以保存有用的视力。

Objective To investigate the curative effects of vitrectomy combined with scleral bucking and intraocular silicone oil or perfluoroethane （C2F6）tamponade for later stage acute retinal necrosis（ARN）. Methods The clinical data of 10 eyes with 10 patients of later stage acute retinal necrosis combined with retinal detachment, included clinical manifestation, auxiliary examination and management were retrospectively analyzed.The following time was 2 to 32 months,averaged 15.20±10.84 months.Results At the end of our following up,the retina had been well reattached in 8 eyes,partly reattached in 1 eye, and detachment recurrence occurred in 1 eye.Of all the 9 eyes tamponaded with silicone oil,6 eyes had been performed silicone oil removal, and the retina was well attached in 5 eyes.The vision： 8 eyes had improved vision, 1 eye kept the same vision,and only one eye decreased to hand movement before the eye.Hypotony has happened in 2 eyes.Conclusion Retinal detachment caused by later stage ARN could be well reattached by vitrectomy, and the vision could be improved at the same time.To prevent hypotony, it has been suggested that if the patient has been performed retina dissection or excision in large area the silicone oil could not be removed until the complication has occurred.