急性视网膜坏死综合征的玻璃体手术治疗

Treatment of acute retinal necrosis （ARN） by vitrectomy

目的研究急性视网膜坏死的玻璃体手术治疗的时机和疗效。方法对13例（14只眼）伴有或将会发生视网膜脱离的ARN患者行玻璃体手术治疗。其中5只眼加行巩膜外加压或环扎术，3只眼行晶状体切除，4只眼行30～360度视网膜切开，10只眼注入硅油，2只眼注入C3F8。结果随访3月至3年，术后有2只眼复发视网膜脱离，其中1只眼发生黄斑前膜、牵拉性视网膜脱离；另1只眼为取出硅油后出现视网膜裂孔、视网膜脱离。术后视网膜复位率为85．7％（12／14）。术后6只眼（42．9％）视力有提高。结论对于并发视网膜脱离或具有视网膜脱离危险因素的ARN患者行玻璃体手术疗效肯定，可保存和提高视功能。

Objective To invesgate the effectiveness and the selection of operating juncture for the treatment of acute retinal necrosis （ARN） by vitrectomy. Methods Thirteen cases （ 14 eyes） of ARN had undertaken the vitrectomy including scleral surgery for 5 eyes and retina discussion from 30-360° for 4 eyes. Ten eyes were tamponaded with silicone oil and 2 eyes with C3F8 gas in eyes. Results Followed up from three months to 3 years, 2 eyes had recurrent retinal detachment after the operation, one with macular epireti- nal membranes and the other with retinal detachment subsequent to retina hole after the surgery of silicone oil removal. The rate of retinal attachment was 85.7% （12/14）, visual acuity increased in 6 eyes （42.9%）. Conclusions Selecting adequate juncture to carry out vitrectomy for ARN can avoid the occurrence or development of retinal detachment and increase or keep effective visual acuity.