视网膜周边激光光凝对下方裂孔硅油取出后视网膜再脱离的影响

The effect of prophylactic 180～ peripheral laser retinopexy during primary vitrectomy surgery on inferior rhegmatogeuous retinal redetachment after silieone oil removal

目的探讨首次玻璃体手术中下方周边部180°视网膜光凝对下方裂孔性视网膜脱离硅油取出手术后再脱离的影响。方法对142例（142只眼）下方裂孔性视网膜脱离行玻璃体视网膜手术硅油填充，尔后行硅油取出的临床资料进行回顾性分析。激光光凝组81例为首次行玻璃体手术时即对其下半180°周边部视网膜（除裂孔外）实施堤坝样光凝；对照组61例未行预防性视网膜激光光凝。结果硅油眼内填充时间为7～24周，平均硅油填充时间（11．8±2．6）周。硅油填充期间，光凝组硅油填充状态下视网膜脱离6例，占7．4％，对照组视网膜脱离10例，占16．4％，两组硅油状态视网膜脱离发生率比较，差异有统计学意义（P〈0．05）。油下视网膜脱离16例中，激光组6例。4例为增生性玻璃体视网膜病变引起，1例为预防性激光光凝手术后激光斑因受附近增生膜牵拉形成的新裂孔，1例原因不明：对照组10例，7例为遗漏小裂孔或原裂孔重新开放，3例为增生性玻璃体视网膜病变引起。硅油取出手术后11例患者发生视网膜再脱离，其中激光组3例，占3．7％；对照组8例，占11．4％。两组硅油取出后视网膜再脱离发生率比较，差异有统计学意义（P〈0．05）。硅油取出手术后视网膜再脱离11例中，激光组3例，2例为激光光凝斑受附近增生膜牵拉形成的新裂孔，1例为激光孔；对照组8例，4例为增生性玻璃体视网膜病变，2例为原裂孔开放，2例为原裂孔相邻部新裂孔。结论下方裂孔性视网膜脱离在首次玻璃体手术中行预防性下半侧周边部180°视网膜激光光凝与裂孔愈合和硅汕取出手术后视网膜再脱离发生率下降有关联。

Objective To investigate the effect of prophylactic 180°peripheral laser retinopexy during primary vitrectomy surgery on inferior rhegmatogenous retinal redetachment after silicone oil removal. Methods The clinical data of 142 patients who tmdertaken previous vitrectomy combined with silicone oil tamponade and later silicone oil removal surgery were retrospectively analyzed.Eighty-one patients （photocoagulation group） was taken prophylactic 180-degree dykelike laser retinopexy during the previous vitreoretinal surgery before the secondary silicone oil removal while 61 patients （control group） weren＇t.The incidence, time, the cause of retinal redetachment and the complications of laser retinopexy after silicone oil removal in two groups were observed.Results The duration of silicone oil tamponade was 7-24 weeks, averaging 11.8-2.6 weeks.During the period above, 16 cases of retinal redetachrnent occurred; among them, there were 6 cases （7.4 %） in the photocoagulation group （4 proliferative vitreoretinopathy cases, 1 new break case, 1 unknown case） and 10 cases （16.4 % ） in the control group （7 cases resulted from omission of small retinal breaks or reopening of original hole, 3 proliferative vitreoretinopathy cases）.The difference between two groups was statistically significant （P〈0.05）.Eleven cases of retinal redetachment were recorded after silicone oil removal, including 3 cases （3.7 %） in photocoagulation group （2 cases resulted from new tractional hole by nearby proliferative membrane, 1 photocoagulation spot hole case） and 8 cases （ 11.4 % ） in control group （4 proliferative vitreoretinopathy cases, 2 reopening of primary retinal break cases, and 2 newly formed breaks beside the primary retinal breaks ）.Conclusions Prophylactic 180-degree peripheral laser retinopexy during primary vitrectomy surgery on inferior rhegmatogenous retinal redetachment is associated with a decrease of the incidence of retinal redetachment after removal of silicone oil.