裂孔源性视网膜脱离的最小量巩膜外加压手术

Minimal scleral buckling for primary rhegmatogenous retinal detachment

目的探讨原发性裂孔源性视网膜脱离巩膜外加压手术的最小量手术方式及其效果。方法裂孔源性视网膜脱离22例(22眼),在直视下行球结膜环形剪开、四直肌预置牵引线,在间接检眼镜下行视网膜裂孔精确定位及中度冷凝,巩膜缝线固定外加压块,所有外加压均采用修剪后的小硅胶海绵块,只固定巩膜褥式缝线1对。多发性裂孔于每个裂孔处分别于巩膜表面以1对褥式缝线固定硅胶海绵。所有手术眼均未行环扎术。手术后随访3～6月。结果所有患者手术过程顺利,无一例术中并发症,手术损伤小;手术后眼底检查外加压精确地顶压裂孔,视网膜完全复位20眼,2眼高度近视于手术后2周视网膜脱离复发经玻璃体手术后视网膜复位;手术后视力提高者18眼,不变2眼,下降2眼。结论最小量的外加压手术的优点是精确、可靠、创伤小,能避免传统巩膜扣带手术的一些并发症,手术成功率高。

Objective To study the effect of the minimal scleral buckling for primary rhegmatogenous retinal detachment.Methods 22 eyes with rhegmatogenous retinal detachment were enrolled in the study.The entire fundus was examined by indirect ophthalmoscopy.The position of each retinal break was marked externally on the sclera.Cryotherapy was applied.A thin and little silicone rubber sponge was placed episcleral by one pair of suture to create a seleral buckle.Multiple retinal holes in different quadrants were supported by separate scleral buckle.The scleral encircling was not used.All patients were followed up for 3～6 months.Results All retinal holes were supported on the scleral buckle.In 22 eyes.20 eyes got complete retinal reattachment.The visual acuity improved in 18 eyes,no change in 2 eyes,hypopsia in 2 eyes.Conclusions The minimal scleral buckling for primary rhegmatogenous retinal detachment can reduce the complications of conventional scleral buckling and maintain a high success rate.