三面镜联合显微镜直视下定位视网膜裂孔的临床观察

Clinical observation of three-mirror lens combined with microscope in localization of retinal holes

目的:探讨三面镜裂孔定位法联合显微镜直视下裂孔定位法在视网膜脱离外路显微手术中运用的疗效观察。方法:回顾性分析2007-10/2009-05因裂孔性视网膜脱离而做视网膜脱离外路显微手术的连续患者52例52眼(70个裂孔)。术前用三面镜检查确定视网膜裂孔距离角膜缘的直线距离和钟点位置,作为手术中指导硅胶填压在已发现裂孔对应巩膜上的依据,放液后在显微镜直视下更精确的定位裂孔并360°常规检查9～20mm以前的视网膜,处理变性区及新裂孔。结果:在52例52眼70个裂孔(包括术中发现的3个新裂孔及1个医源性孔)患者术后复诊观察,仅1例术后视网膜没有复位,因为该患者在三面镜及显微镜下都没有发现明显裂孔,仅仅处理了可疑变性区。还有1例为术后1mo因外伤视网膜脱离复发。术后视网膜脱离复位率达到了98%。结论:术前三面镜裂孔定位法联合术中显微镜下裂孔定位更准确,并可消除裂孔的漏诊,对周边的变性区可以进行预防性的冷冻处理,提高了手术的成功率及视功能的恢复,减少了视网膜脱离的复发。

AIM： To observe the clinical effect of three-mirror lens combined with microscope in localization of retinal holes. METHODS： From October 2007 to May 2009, consecutive retinal detachment （RD） 52 patients （52eyes, 70 breaks） were enrolled in this study. The locations of breaks were estimated by three-mirror lens preoperatively based on which the solid silicone rubber was placed under microscope. After the drainage of subretinal fluid , the holes were located more precisely under surgical microscope;360 degree routine examination was performed to observe the retina; denaturation zone and new retinal holes were dealed with. RESULTS： After surgery,all the RD 52 patients （52 eyes, 70 breaks） （ include 3 new breaks in surgery and 1 medical origin break ）, were followed up. Only 1 patient didn＇t occur reattachment, because this patient didn＇t find breaks under three-mirror lens and microscope, and only the questionable denaturation was dealed with. After 1 month, there was one case with recurrent retinal detachment due to trauma, and the reposition rate after surgery was 98%. CONCLUSION： Three-mirror lens combined with microscope was accurate in the location of retinal holes, which can eliminate missed diagnosis. Preventive freezing for denaturization zone can improve the success rate of surgery and the recovery of visual function and reduce the recurrence of retinal detachment.