视网膜血管鞘膜切开治疗视网膜分支静脉阻塞

The clinical effection of sheathotomy on branch retinal vein occlusion.

目的探讨玻璃体切除联合视网膜血管鞘膜切开术对视网膜分支静脉阻塞的疗效。方法对39例(39眼)视网膜分支静脉阻塞行标准的三通道玻璃体切除手术。切除后玻璃体,升高眼压以减少出血。利用一弯头的MVR刀切开内界膜,在动静脉交叉点外远端100～200μm处切开视网膜内层,然后将动脉和神经纤维行钝性分离。最后,利用MVR刀将动静脉交叉处的血管外膜切开,当动脉与其后的静脉分离,并可被挑起,表明分离成功。气-液交换后注入惰性气体0.8mL于玻璃体腔。在术后1、2、3、6、12个月进行视力、荧光素眼底血管造影、视野及黄斑部光学相干断层扫描等检查。结果 39例中,有32例分支阻塞的血管获得完全再通,3例部分再通,4例血管仍然阻塞;其中视力提高者28例,视力保持不变者9例,2例因发生视网膜脱离视力下降。视野及囊样黄斑水肿较术前改善的有18例。结论玻璃体切除联合视网膜血管鞘膜切开治疗视网膜分支静脉阻塞是一种安全有效的方法。

Objective To study the The clinical effection of sheathotomy on branch retinal vein occlusion. Methods the stangard vitreous surgery were carried for 39 palients（ 39 eyes） who underwent the BRVO. after vitretomy the IOP was improved to stop the hemorrhage, use a curved MVR knifto cut the ILM, and cut the inner retinal from 100-200urn of the point of cross of vein and artery, then apart the atery and nerve layer in blunt power, at last carry the sheathotomy, after the vein and artery aparted, the vein can be moved that indicated the successful of sheathotomy, after that, carried the gas-fluid exchange,0. 8ml inertia gas was injected in the vitreous cavity, the vision acqnity, FFA, vision field and OCT were examined at 1,2,3,6,12 months postoperation. Results Among 39 patients, 32 cases＇ occlusied vein were reperfusioned compeletly,3 cases partly reperfusioned,4 cases were occlused still. 28 cases＇ vision improved after sheathotomy. 9 cases had no change, 2 cases＇ vision decreased for retinal detachment, there were 18 cases visionfield and macular edema improved. Conclusion the vitrectomy combined with sheathotomy is a safe and effective method for branch retinal vein occlusion.