最小量巩膜外垫压术治疗孔源性视网膜脱离的疗效分析

Minimal segmental scleral buckling surgery for rhegmatogenous retinal detachment

目的比较分析最小量巩膜外垫压术与巩膜环扎垫压术治疗孔源性视网膜脱离的疗效。方法回顾性分析2008年3月至2009年3月收治的20例(20只眼)孔源性视网膜脱离患者行最小量巩膜外垫压术(A组)的临床资料,并在同期住院行巩膜环扎垫压术的孔源性视网膜脱离患者中随机选择40例(40只眼)作为对照组(B组),术后随访比较两组的视网膜复位率、最佳矫正视力及并发症情况。结果术后视网膜首次复位率A组为90%,B组为95%;最佳矫正视力A组为0.48±0.33,B组为0.48±0.28;增生性玻璃体视网膜病变(PVR)进展者A组占5%,B组占10%,两组间均没有显著差异(P=0.4642、0.9662、0.5089)。术后A组出现复视1只眼,B组出现短期高眼压3只眼,黄斑水肿1只眼,复视1只眼;两组术后屈光度的变化有显著差异(P=0.0019),前房深度、眼轴长度及散光度的变化均没有显著差异(P=0.5444、0.8732、0.0582)。结论外加压手术是一种有效复位脱离视网膜的手术方式,最小量巩膜外垫压术对孔源性视网膜脱离能获得很好的疗效,而对眼球创伤小、仅改变眼局部形态结构,能避免传统巩膜环扎垫压术的一些并发症,但远期疗效还有待进一步观察。

Objective To compare the therapeutic effects of minimal segmental scleral buckling surgery and conventional scleral buckling in rhegmatogenons retinal detachment. Methods In this research, the postoperative retinal reattaehment rate, best corrected visual acuity and complications of 60 eyes with rhegmatogenous retinal detachment treated during March 2008 to March 2009 were retrospectively studied. Of the 60 eyes, 20 eyes were performed with minimal segmental scleral buckling surgery （ group A） compared with the control group of 40 other randomly chosen eyes performed with conventional scleral buckling surgery （ group B ）. Results The primary reattaehment rate was 90% in group A and 95% in group B. Best corrected visual acuity was 0.48 ± 0.33 in group A and 0.48 ± 0.28 in group B. PVR developed in 5% of the eyes in group A and 10% in group B. There are no significantly differences between the two groups in all three aspects （ P = 0.4642, 0. 9662 and 0. 5089, respectively）. Complications happened in both groups, of which 3 eyes intraecular hypertensions , 1 eye maeular oedema and 1 eye diplopia in group B while 1 eye diplopia in group A. The refraction change was statistically difference between the two groups （ P =0. 0019）, while the changes of anterior chamber depth, axial length and astigmatism were not （ P = 0. 5444,0. 8732,and 0. 0582, respectively）. Conclusion Extraocular pressure opelation is an effective surgical method to treat retinal detachment, and the minimal segmental seleral buckling surgery can cure rhegmatogenous retinal detachment well which has less injury and can avoid some of the complications, but the longterm efficacy remains to further observation.