急性视网膜坏死综合征硅油填充术后硅油取出时机选择

Clinic analysis of the appropriate silicone oil removal timing in silicon oil tamponade eyes with acute retinal necrosis syndrome after the management of vitrectomy

目的观察急性视网膜坏死综合征（ARN）行玻璃体切除联合硅油填充术后硅油充填期间及硅油取出术后并发症,进而探讨硅油取出的适宜时机。方法对连续就诊的伴有视网膜脱离的48例（48只眼）ARN患者实施玻璃体切除视网膜复位联合硅油填充术,对于确认视网膜已经复位,没有活动性的增生病变及视网膜裂孔,并在视网膜变性区域补充激光光凝的所有患者经不同时长的硅油填充期后实施硅油取出术,回顾分析其硅油填充期间及硅油取出术后并发症如视网膜脱离、并发性白内障、继发性青光眼、角膜变性等的发生情况。结果硅油填充术后视力总体上较术前有明显提高;硅油填充时间为3~15个月,平均5.8个月。取出硅油之后,总体视力无明显改变;8例于取硅油术后随访期内发生视网膜再脱离;1例角膜变性的病例,在硅油取出之后无明显改变;5例并发性白内障取油时实施超声乳化联合人工晶状体植入术;6例发生脉络膜脱离经药物治疗后痊愈;24例在硅油取出之后晶状体混浊程度较硅油取出术前无明显改变;3例无晶状体眼患者取油术后裸眼视力下降,但最佳矫正视力同硅油取出术前。结论硅油填充及硅油取出术的并发症主要为视网膜再脱离、脉络膜脱离、并发性白内障、继发性青光眼、硅油乳化、角膜变性、低眼压等。对于ARN而言,硅油填充时限4~6月时取油术后视网膜再脱离的发生率较低,取油较为适宜。

Objective To observe the complications duration of silicone oil tamponade and after silicone oil removal with acute retinal necrosis syndrome undertaken the management of vitrectomy,and estimate the appropriate silicone oil removal timing in silicon oil tamponade eyes.Methods 48 consecutive eyes diagnosed of acute retinal necrosis syndrome were treated with vitrectomy,retinal photocoagulation,air/fluid exchange and silicone oil injection.After 3 months to 13 months of tamponade（average 5.8 months）,silicone oil was removed.Best corrected visual acuity（BCVA）,intraocular pressure,retinal situation and complications of during silicone oil tamponade and after silicone removal were examed.Results The BCVA improved after vitreoretinal surgery（P0.05）,while no significant differences were detected between before and after silicone oil removal（P=0.383）.After silicone oil removal,recurrent retinal detachment occurred in 8 cases,choroidal detachment and ocular hypotension occurred in 6 cases,etc.The complications associated with silicone oil tamponade included secondary glaucoma,complicated cataract,corneal degeneration,silicone oil emulsion,etc.The complications associated with silicone oil removal included recurrent retinal detachment,choriodal detachment,etc.Conclusion As for acute retinal necrosis syndrome undertaken the management of vitrectomy,the advisable timing of silicone oil removal was 4 to 6 months after silicone oil injection.Reasonable prolonged silicone oil tamponade duration could lead to good final outcomes.