显微外路手术治疗巩膜穿刺孔玻璃体嵌顿引起的巨大裂孔

External route microsurgery for secondary giant retinal tear during or after vitrectomy

目的:探讨显微外路视网膜脱离手术在玻璃体切除手术中巩膜穿刺孔玻璃体嵌顿引起的视网膜巨大裂孔的处理疗效。方法:回顾性分析本院2008-06/2010-02在显微镜直视下环扎、硅胶填压、巩膜外冷凝、C3F8眼内填充处理玻璃体切除手术中因巩膜穿刺孔玻璃体嵌顿引起的视网膜巨大裂孔4眼、术后发生的视网膜巨大裂孔8眼的术后效果。结果:术后随访2～15(平均6)mo,11眼视网膜完全复位,1眼术后1mo再脱离,再行显微外路手术复位。术后矫正视力<0.1者4眼(33%);0.1～0.3者5眼(42%);≥0.4者3眼(25%)。结论:巩膜穿刺孔玻璃体嵌顿引起的视网膜裂孔是一种严重的并发症,而且常常裂孔巨大,对这类患者采用显微镜直视下环扎、硅胶填压、巩膜外冷凝、C3F8眼内填充处理是一种安全有效的方法。

· AIM：To study the effect of external route microsurgery for giant retinal tear（GRT）caused by vitreous incarceration in the inner aspect of sclerotomy sites during or after vitrectomy.· METHODS：From June 2008 to February 2010,12 cases of patients with GRT related to vitreous incarceration of sclerotomy were treated using external route microsurgery and analyzed retrospectively.The encircling,silicone buckle,transscleral cryopexy and perfluorapropane tamponade were performed under a surgical microscope.Among them,4 cases of GRT were treated intraoperatively and 8 cases were occurred and treated postoperatively.· RESULTS：The following up time ranged from 2 to 15 months（mean 6 months）.The retinas were reattached in eleven eyes after one operation.The retina was redetached in one eye one month later and another microsurgery was performed.At last,retinal reattachment was achieved in all patients.The postoperative best-corrected visual acuity was lower than 0.1 in 4 eyes（33%）,0.1-0.3 in 5 eyes（42%）and higher than or equal to 0.4 in 3 eyes（25%）.· CONCLUSION：The GRT related to vitreous incarceration of sclerotomy is a serous surgical complication.It is a secure and effective technique that the encircling,silicone buckle,tranascleral cryopexy and perfluorapropane tamponadd are used to treat the complication under the surgical microscope.·