伴脉络膜脱离的黄斑裂孔性视网膜脱离术前皮质类固醇激素的治疗作用研究

The efficacy of corticosteroid administration prior to vitrectomy for macular rhegmatogenous retinal detachment with choroidal detachment

目的探讨伴有脉络膜脱离的黄斑裂孔性视网膜脱离术前皮质类固醇激素的应用价值。方法对确诊为伴有脉络膜脱离的黄斑裂孔性视网膜脱离68例（68只眼），分为术前激素治疗组29例（29只眼），按激素禁忌与否给予地塞米松15mg静脉滴注和（或）1％泼尼松龙滴眼液。另一组39例（39只眼）在术前不给予激素治疗。在玻璃体手术后比较二组一次性视网膜解剖复位率、视力和视网膜脱离再发情况。结果29只眼激素治疗后1周内62％脉络膜脱离复位，脉络膜脱离复位与否玻璃体手术一次性解剖复位率分别为83．3％与90．7％，二者对比差异无统计学意义（P〉0．05）。激素治疗组与直接手术组一次性视网膜脱离解剖复位率为86．2％、89．7％，二者差异也无统计学意义（P〉0．05）。视力预后二者视力提高者直接手术组略高于激素治疗组，视网膜脱离复发率二组相当。结论对于伴有脉络膜脱离的黄斑裂孔性视网膜脱离，及早手术是决定预后的关键，脉络膜脱离存在与否对视网膜脱离复位及视力无明显影响，术前皮质类固醇激素的应用无重要意义。

Objective To evaluate the efficacy of corticosteroid administration prior to vitrectomy for macular rhegmatogenous retinal detachment with choroidal detachment.Methods Of 68 cases of macular rhegmatogenous retinal detachment with choroidal detachment, 29 cases （Group A）received intensive 1% pre- dinisolone acetate eye drops or intravenous injection of 15 mg Dexamethasone or both above,and 39 cases （Group B）received pars plana vitrectomy and didn＇t undertake any corticosteroid treatment.Main outcome measures：the rate of single-operation anatomic reattachment success,the rate of postoperative redetachment and the visual acuity.Results 18 eyes（62% ）in Group A got choroidal reattachment in a week., the single operation anatomical rate of choroidal reattachment was 83.7% for Group A and 90.7% for Group B.The rate of anatomic retinal reattachment was 86.2% for Group A and 89.7% for Group B, the difference between them did not reach statistical significance （P 〉0.05 ）.The vision improvement was a little more in Group B than that in Group A., however the rate of redetachment was almost the same after following-up.Conclusions vitrectomy as early as possible played an important role in treatment of macular rhegmatogenous retinal detachment with choroidal detachment; the existence of choroidal detachment didn＇t have an effect on the reattachment of retinal detachment and the improvement of visual acuity.The corticosteroid administration prior to vitrectomy had no clinical significance.