巩膜环扎术是否必须?——玻璃体视网膜手术方法的探讨

If the encircling scleral buckling is necessary?——a discussion of operation in rhegmatogenous retinal detachment with vitrectomy

目的探讨巩膜环扎带对玻璃体手术治疗孔源性视网膜脱离(RRD)治愈率及视力预后的影响。方法回顾分析有随访纪录的以玻璃体手术治疗的孔源性视网膜脱离140例(140眼)(除去黄斑孔),按是否做巩膜环扎术分为环扎组和非环扎组。比较环扎组与非环扎组在不同增生型玻璃体视网膜病变(PVR)分级及裂孔不同位置的复位率以及两组术后视力的改善情况。结果环扎组79眼,视网膜完全复位67眼,复位率84.81%。非环扎组61眼视网膜完全复位52眼,复位率85.25%。非环扎组视网膜解剖复位率略高于环扎组,但差异无统计学意义(P>0.05)。两组在不同PVR级别以及裂孔不同位置的视网膜复位率相比差异无统计学意义(P>0.05)。术后视力改善者,环扎组63眼占79.75%;非环扎组49眼占80.33%,两组间差别无统计学意义(P>0.05)。结论有玻璃体手术指征的RRD提高玻璃体视网膜手术成功率的关键是彻底松解视网膜固定皱襞及裂孔周围的牵引,彻底地封闭所有视网膜裂孔及有效的眼内填充,巩膜环扎术并非必须。

Objective To evaluate the effect of encircling scleral buckling operation in rhegmatogenous retinal detachment （RRD） with vitreetomy. Methods A total 140 eyes suffering RRD （without macular hole） which experienced once vitreetomy were studied, including 79 eyes with scleral buckling and 61 eyes without scleral buckling. The differences of the reattachment rate and the improvement of visual acuity between the two groups were compared. Results The retina reattched in 67 eyes （84.81%） of buckling group and 52 eye （ 85.25% ） of nonbuckling group. There was no statistical significant differences in the rate of retinal reattachment between the two groups. Differences in PVR grade and positions of the retinal tears can lead to an identical outcome. Rate of improvement of visual acuity in buckling group is 79.75% （63 eyes）, while which in nonbuckling group is 80. 33% （49 eyes）. Significant difference can not be found. Conclusion The scleral buckling operation is not a necessary procedure to improve the rate of retinal reattaehment in RRD with vitreetomy, while perfect vitreetomy and effective intraocular tamponade are the key factors.