玻璃体切除术治疗较复杂型孔源性视网膜脱离的临床研究

The Clinical Study Of The More Complex Rhegmatogenous Retinal Detachment Cured By The Pars Plana Vitrectomy

目的探讨玻璃体切除术治疗较复杂型孔源性视网膜脱离的临床疗效。方法对2006年8月至2007年6月期间PVRB-C2，视网膜裂孔在大小、形态、数目及分布上特殊的较复杂型视网膜脱离病例40例（40只眼）随机分为两组，分别采用经睫状体扁平部玻璃体切除术（PPV）和巩膜扣带术（SB）进行治疗。术前、术后1月、3月行常规检查，随访6～14月，采用SPSS13．0统计学软件进行分析，比较两组病例的一次性及最终视网膜复位率；术前术后最佳矫正视力变化情况；术后术眼的眼轴长度、角膜散光度、眼屈光度的变化情况及术后各种并发症的发生情况。结果（1）一次性及最终视网膜复位（率）PPV组与SB组差别无统计学意义（P〈0．05）。（2）PPV组最佳矫正视力提高率和提高程度均高于SB组（P〈0．05）。（3）①PPV术式对术眼术后眼轴长度、角膜散光度、眼屈光度改变的影响不大，术后1月、3月与术前相比差异均无统计学意义（P〉0．05）；②SB术式术眼术后1月、3月眼轴长度较术前增长，但是改变无统计学意义（P=0．1818，P〉0．05）；而角膜散光度较术前明显增加，且术后1月、3月与术前相比差别均有统计学意义（P〈0．05）；眼屈光度术后1月、3月与术前相比，均向近视方向增加，但是仅术后1月与术前比较，差异有统计学意义（P〈0．05），术后3月与术前比较差别无统计学意义（P〉0．05），说明SB术式术后早期对术眼影响较大，但随着术后时间的延长，影响会逐渐减小。（4）两组术后可引起不同的并发症，但总体上PPV术式引起的并发症比SB术式少。结论采用玻璃体切割术治疗较复杂型孔源性视网膜脱离是一种安全、有效、可行的方法。在技术条件允许时，首选玻璃体手术治疗较复杂型孔源性视网膜脱离，更有利于提高患者视功能恢复的程度及速度，并减少并发症的发生。

Objective To approach the clinical effects of primary pars plana vitrectomy （PPPV） in the treatment of more complex rheginatogenous retinal detachment （RRD） without scleral buckling （SB）. Methods Forty patients （40 eyes） with more complex primary rhegmatogenous retinal detachment were included in this study. For all patients： proliferative vitreoretinopathy （PVR） grade were B to C2 and the sizes, shapes, locations, amounts of the retinal tears / holes were more complex. The patients were divided into two groups randomly： one group treated by PPV （PPV Group） while the control one treated with SB （SB Group）. All the patients were followed up for 6 - 14 months. The data collected included visual acuity, the condition of the retina and the retinal tears, IOP, axial length of the eyeball, corneal curvature and refraction preoperatively and postoperatively. Postoperative complications also were collected. All the data were analyzed by SPSS 13.0. Results 1. The retinal reattached rate between the two groups had no statistic difference （Pone=0.676, Pre=1. 000; P〈 0.05 ）. 2. The rate and the degree of the best corrected visual acuity of PPV group were significantly higher than that of SB group （Prate=0.0383, pdeg=0.0479, P〈0.05 ）.3. （ 1 ） Compared with preoperative data, the length of axis oculi, the corneal astigmatism and the refraction of PPV group in 1 month and 3months postoperatively had no statistically change （Paxis=0.9771, Pastigmatism=0.8262, Prefraction=0.9532, P〉0.05）. （2） For SB group, the length of the axis oculi of the operation eye increased postoperatively, but the difference had no statistical significance （P=0.1818, 〉0.05 ） while the corneal astigmatism statistically increased either in 1 month or in 3 months postoperatively （P1month=0.005, P3month=0.0357, P〈0.05）. The refraction developed myopia shift postoperatively. But the differences had statistical significances only in 1 month postoperatively （P1=0.012, P〈0.05）, but not in 3 months postoperatively （P3=0.2034, P〉0.05）. 4. Complications： The incidence rates of the earlier period cataract and the high intraocular pressure （IOP） of PPV group were higher than those of the SB group statistically （x^2catract=21.5385, P=0.000; X^2iop=4.2857, P=0.0383; P〈0.05 ）. The incidence rates of the macular retinal fold and dysmorphopsia of the PPV group were significantly lower than those of the SB group （x^2fold=4.444, P=0.0349; x^2dysmorphopsia=29.5652, P=0.000, P〈0.05）. But there was no significant difference in the incidence rates of the PVR, corneal edema and retinal hemorrhage between the two groups （x^2PVR=1. 111, P=0.2912; x^2edema=2.0571, P=0.151; x^2hemonrhage=0.000, P=1.000; P〉0.05）. Conelusions Primary pars plana vitrectomy is safe, effective and reliable in the treatments of more complex RRD. It can result in sooner recovery, better vision and fewer complications.