重硅油填充治疗下方裂孔源性视网膜脱离的临床研究

Clinical research of complicated retinal detachment with inferior breaks using a heavy silicon oil as temporary tamponade

目的评价用重硅油填充治疗下方裂孔源性视网膜脱离伴严重增生性玻璃体视网膜病变(PVR)的手术效果及并发症。方法对下方视网膜裂孔和严重PVR的复杂性视网膜脱离12例(12只眼)行玻璃体切割联合玻璃体腔重硅油填充术。术后对视力、角膜、眼底及眼压等情况进行随访。结果术后随访2.5～27个月,平均7.7个月,83.3%的病例视网膜裂孔封闭、视网膜完全复位;术后视力6只眼(50%)提高,4只眼(33.3%)不变;2只眼(16.7%)下降;4只眼(33.3%)术后眼压异常,其中2只眼(16.7%)为一过性低眼压,2只眼(16.7%)为一过性高眼压;2只眼(16.7%)并发性白内障;2只眼(16.7%)重硅油乳化;1只眼(8.3%)重硅油进入前房;1只眼(8.3%)严重的前房炎症反应。结论对下方裂孔源性视网膜脱离伴严重PVR,行玻璃体切割联合玻璃体腔重硅油填充术,可获得满意的视网膜复位率,而且并发症的发生率低。

Objective To assess the efficacy and the incidence of complications of a heavy silicon oil as temporary internal tamponade in selected cases of the complexity and severe PVR retinal detachment with inferior breaks.Methods Vitrectomy combined with intravitreal heavy silicone oil tamponade（Oxane Hd）was performed in twelve eyes of twelve patients.Postoperative vision,cornea and intraocular pressure,and so on were followed up.Results All patients were followed up for 2.5～27 months with an average of 7.7 months.Of all cases,11 cases（83.3%） closed retinal breaks and reattached retina,6 cases（50%） showed improvement in visual acuity,4 cases（33.3%） remained visual acuity within one line of baseline and 2 cases（16.7%） showed visual acuity decreased after the surgery.After surgery intraocular pressure was normal in all except 7 cases（59%）with abnormal intraocular pressure,included 2 case（16.7%） of temporary low pressure and 2cases（16.7%） temporary high pressure.In all patients,there were 2 case（33.3%） of complicated cataract,2 case（16.7%） of silicon oil emulsification,1 case（8.3%） of tamponade in the anterior chamber and 1 case（8.3%） of excessive postoperative inflammation in anterior chamber.Conclusion Treating the inferior breaks associated with the complexity and sever PVR retinal detachment with vitrectomy combined with intravitreal heavy silicone oil tamponade（Oxane Hd） could secure a satisfactory rate of retinal reattachment,whereas the incidence of complications is low.