下直肌牵引、玻璃体腔注气在下方孔源性视网膜脱离术中的应用

Application of inferior rectus hauling and intravitreal gas injection in inferior rhegmatogenous retinal detachment surgery

目的观察下直肌牵引、玻璃体腔注气治疗下方孔源性视网膜脱离的临床疗效。方法将我院收治的67例(68眼)下方孔源性视网膜脱离患者随机分为外路手术组(34例35眼)和联合手术组(33例33眼)。外路手术组进行巩膜外冷冻、垫压或(和)环扎术,联合手术组进行巩膜外冷冻、垫压或(和)环扎及玻璃体腔注气,术中行下直肌牵引术。对2组患者术后视网膜复位情况及并发症进行比较分析。结果外路手术组8眼视网膜未复位,占22.86%,联合手术组1眼视网膜未复位,占3.03%,2组比较差异有统计学意义(χ2=5.814,P<0.05)。外路手术组发生PVRD级2眼(8.3%),联合手术组发生PVRD级1眼(3.0%),均发生在视网膜未复位患者。外路手术组视力提高24眼(68.6%),不变11眼(31.4%),联合手术组视力提高31眼(93.9%),不变2眼(6.1%)。结论下直肌牵引、玻璃体腔注气治疗下方孔源性视网膜脱离安全有效,是一种理想的手术方法,值得推广应用。

Objective To investigate clinical therapeutic efficacy of inferior rectus hauling and intravitreal gas injection for inferior rhegmatogenous retinal detachment.Methods About 67 patients（68 eyes）with inferior rhegmatogenous retinal detachment patients were randomly divided into external detachment surgery group（34 cases,35 eyes）and the union surgery group（33 cases,33 eyes）.The external detachment surgery group were taken outside scleral cryotherapy,pad or（and）encircling,the union surgery group performed outside scleral cryotherapy,pad or（and）encircling,intravitreal gas injection,and intraoperative inferior rectus hauling.Postoperative retinal positioning and complications were analyzed and compared between the two groups.Results There were 8 eyes（22.86%）without retinal positioning in external detachment surgery group,and 1 eye（3.03%）in the union surgery group,there was statistical difference（χ2=5.814,P0.05）.There were 2 eyes（8.3%）at PVR D level in external detachment surgery group,1 eye（3.0%）in the union surgery group,and all were without retinal positioning.Visual acuity of 24 eyes（68.6%）improved and 11 eyes（31.4%）unchanged in external detachment surgery group.Visual acuity of 31 eyes（93.9%）improved and 2 eyes（6.1%）unchanged in the union surgery group.Conclusions Inferior rectus hauling and intravitreal gas injection is a safe,effective and ideal way for inferior rhegmatogenous retinal detachment,and is worth clinical popularizing.