显微镜直视下巩膜外冷凝联合眼内光凝治疗巨大裂孔性视网膜脱离

Scleral cryotherapy combined with intraocular laser photocoagulation under operation microscope on retinal detachments with giant retinal tear

目的探讨应用显微镜直视下巩膜外冷凝联合眼内光凝玻璃体切割术治疗巨大裂孔性视网膜脱离手术效果。方法巨大裂孔性视网膜脱离患者19例19眼均行玻璃体切割、手术显微镜直视下巩膜外冷凝联合眼内光凝,玻璃体腔填充硅油进行治疗。术后进行随访。结果术后随访6～36个月,平均21.3个月,15例视网膜完全复位(78.9%);视网膜在术后2周至5个月因术后增生性玻璃体视网膜病变的形成导致视网膜裂孔开放而发生再脱离4例(21.1%);完全复位者有11例取出硅油,其中有1例复发;术后6个月视力较术前好转15例,不变3例,仅有1例下降,术后盲目率(26.3%)与术前(78.9%)比较有显著性下降(χ2=10.5263,P<0.05)。术后发生白内障6例,高眼压5例,视网膜下出血3例,玻璃体腔出血2例,角膜带状变性1例。结论应用显微镜直视下巩膜外冷凝联合眼内光凝治疗巨大裂孔性视网膜脱离,术后可得到满意的视网膜复位率及脱盲率。

Objective To explore the operative effectiveness of scleral cryotherapy combined with intraocular laser photocoagulation under operation microscope on retinal detachments with giant retinal tear.MethodsNineteen cases（19 eyes）of retinal detachments with giant retinal tear were enrolled in this study.All cases underwent pars planar vitrectomy,intraocular laser photocoagulation combined with scleral cryotherapy and temporary silicone oil tamponade under operation microscope.The effect on the reattachment rate and visual acuity were evaluated postoperatively.ResultsMean postoperative follow-up time was 21.3 months（ranging from 6 months to 36 months）,15 cases（78.9%）achieved retinal reattachment after the initial surgery;owing to postoperative proliferative vitreoretinopathy caused retinal holes unclosed,4 cases（21.1%）were redetached under silicone oil tamponade postoperative from 2 weeks to 5 months.Among 11 eyes removed silicone oil,recurrent retinal detachment occurred in 1 eye.Postoperative acute vision improved in 15 cases,unchanged in 3 cases and decreased in 1 case.As compared with preoperative blindness rate（78.9%）,the postoperative blindness rate（26.3%）was significantly decreased（χ2=10.526 3,P0.05）.Postoperative cataract occurred in 6 phakic eyes,high intraocular pressure in 5 eyes,subretinal hemorrhage in 3 eyes,vitreous hemorrhage in 2 eyes and band degeneration of cornea in 1 eye.ConclusionsThe intraocular laser photocoagulation combined with scleral cryotherapy and temporary silicone oil tamponade under operation microscope can achieve favorable anatomical and visual results in the treatment of retinal detachments with giant retinal tear.