视网膜脱离巩膜外路术后晚期再脱离的临床分析

Clinical analysis of late recurrent retinal detachment after scleral buckling

目的观察分析孔源性视网膜脱离巩膜外路术后晚期再脱离的原因、治疗方式及预后。方法回顾性分析657例（657眼）孔源性视网膜脱离经巩膜外路手术治疗6个月后再脱离的16例患者（16眼）的临床资料。结果首次术后晚期再脱离的发生率为2．44％。手术至再脱离的时间为6～45个月，平均（23．87±18．46）个月。16例再脱离患者中，11例出现新的裂孔，5例原裂孔再次裂开；增殖性玻璃体视网膜病变（PVR）B级4例，C级10例，D级2例；15例接受再次手术，其中4例仍行巩膜外路手术，11例行玻璃体切割术，13例再次手术成功。术后随访4～16个月，未出现新的脱离。结论孔源性视网膜脱离巩膜外路术后晚期再脱离的发生率较低，原因可能为PVR的加重或玻璃体基底部的牵引。根据玻璃体视网膜的状况选择再次手术方式，预后良好。

Objective To analyse the cause, therapeutic modalities and prognosis of late recurrent retinal detachment after scleral buckling. Methods A total of 657 patients （657 eyes） underwent scleral buckling, and the clinical data of 16 patients （ 16 eyes） with recurrent retinal detachment 6 months after the procedure were retrospectively analysed. Results Late recurrent retinal detachment occurred in 6 to 45 months after primary surgery, （23.87 ± 18.46）months in average, in 2.44% of all the patients. Among the 16 patients with recurrent retinal detachment, 11 experienced new retinal breaks, and old breaks reopened in the other 5. Proliferative vitreoretinopathy （PVR） grade B was found in 4 patients, grade C in 10, and grade D in 2. Fifteen patients were reoperated, among whom 4 received scleral buckling, and the other 11 vitreoretinal surgery. After reoperation, the retina was reattached in 13 cases. The patients were followed up for 4 to 16 months, and no new recurrence was observed. Conclusion Late recurrent retinal detachment after scleral buckling is rare and PVR seems to be an important factor. Reoperation based on the vitreoretinal condition can yield better prognosis.