手术治疗视网膜巨大裂孔的效果

CLINICAL ANALYSIS OF SURGICAL TREATMENT IN GIANT RETINAL TEARS

目的观察视网膜巨大裂孔的手术治疗效果。方法2005年10月～2007年12月,收治视网膜巨大裂孔病人11例(11只眼),其中2例因钝挫伤后视网膜巨大裂孔、周围视网膜在位的病人,给予环扎、巩膜外垫压、冷凝、激光光凝治疗;9例并发视网膜脱离病人行玻璃体切除联合视网膜复位术,7例玻璃体腔填充硅油,2例注入C3F8气体,5例术中切除晶状体。结果随访3～30个月,2例注入C3F8者分别于术后20d、1.5月又发生视网膜脱离,再次手术复位视网膜并注入硅油,其余9例视网膜均在位。1例因晶状体混浊,行超声乳化加人工晶状体植入术。结论视网膜巨大裂孔无视网膜脱离及玻璃体增殖者,可行单纯视网膜复位术;如视网膜裂孔边缘卷曲、出现视网膜脱离及玻璃体增殖,需行玻璃体切除联合视网膜复位术。

Objective To evaluate the effects and outcomes of surgeries on giant retinal tears （GRTs）. Methods Eleven cases （11 eyes） of GRTs were treated from October 2007 to December 2007 in our center. Two eyes of GRTs due to blunt trauma, without retinal detachment, were treated with cerciage, scleral buckling, cryotherapy and laser photocoagulation; nine cases with retinal detachment underwent vitrectomy and retinal reattachment; seven cases used silicon oil as tamponade and two cases used gases （C3F8） ; five cases underwent lensectomy. Results During 3-30 month follow-up, two cases recurred retinal detachment at 20 days and 1.5 months after C3F8 tamponade and were performed retinal reattachment and given silicon tamponade. One cases had phacoemulsification and intraocular lens implantation because of cataract, the rest of the patients showed no retina detachment after surgery. Conclusion For GRTs without retina detachment and vitreous proliferation, retinal reattachment surgery is preferred. For GRTs with vitreous proliferation, retinal detachment or curl margin of the tears, vitereoretinal surgery should be performed.