玻璃体后脱离及其所致周边视网膜裂孔的早期治疗

The correlation of posterior vitreous detachment to peripheral retinal breaks

目的 探讨玻璃体后脱离（PVD）所致周边视网膜裂孔早期诊治对其预后的影响.方法 对25例25只眼由PVD所致周边视网膜裂孔作一临床分析.所有病例均行三面镜检查周边眼底,＋90D前置镜观察眼球运动时玻璃体的状态.采用多波长激光或冷凝治疗周边视网膜裂孔,巩膜外加压与扣带治疗孔源性视网膜脱离（RRD）.结果 7例（7只眼）PVD年龄高于50岁,18例（18只眼）因高度近视所致者年龄在50岁以下.18例中、青年人周边视网膜裂孔应用多波长激光光凝,6例老年人用巩膜冷凝术,唯1例老人并发RRD应用巩膜外加压及扣带术治疗,所有治疗患眼都获得了较好的视力预后.结论 由PVD患者引起的周边视网膜裂孔发生率随年龄增长或近视屈光度而增加,预防性治疗是安全、有效和必需的.

Objective To investigate the effect of early diagnosis and treatment on the prognosis of peripheral retinal breaks caused by posterior vitreous detachment（PVD）. Methods Twenty-five cases（25 eyes）with peripheral retinal breaks caused by PVD were analyzed. The vitreous conditions of 25 eyes were examined biomicroscopically with a ＋90D present lens（slitlamp indirect ophthalmoscope）and a Goldman three mirror contact lens. Peripheral retinal breaks were treated with laser photocoagulation or scleral cryotherapy,and rhegmatogenous retinal detachment（RRD）with explant and scleral buckling surgery. Results Seven cases（7 eyes）with PVD were related with age over 50 years old and 18 cases（18 eyes）due to their higher myopia with lower than 50 years old. Peripheral retinal breaks in 18 patients of juniority were treated by laser photocoagulation and in 6 senile patients by scleral cryotherapy. Only one senile patient complicated with RRD was treated by explant and scleral buckling surgery. All treated eyes received favorable visual prognosis on them. Conclusions The prevalence of peripheral retinal breaks caused by patient with PVD increase with patient＇s age and degree of myopia. Preventive treatment is safe, effective and necessary.