玻璃体视网膜手术治疗先天性视网膜劈裂及其并发症的疗效观察

Efficacy of vitreoretinal surgery for X-linked retinoschisis and its complications

目的观察玻璃体视网膜手术治疗先天性视网膜劈裂（XLRS）及其并发视网膜脱离和（或）玻璃体积血的疗效。方法回顾分析接受玻璃体视网膜手术治疗的XLRS并发视网膜脱离和（或）玻璃体积血患者21例27只眼的临床资料。所有患眼眼底及光相干断层扫描（OCT）检查均发现黄斑微囊样劈裂病变合并周边部视网膜劈裂。平均视力0．11±0．09，黄斑劈裂平均面积为（1．09±0．56）mm2。12只眼并发孔源性视网膜脱离，5只眼并发牵拉性视网膜脱离，6只眼并发玻璃体积血，4只眼同时合并视网膜脱离和玻璃体积血。均行经扁平部三通道闭合式玻璃体切割手术。根据情况行内界膜剥离，眼内激光光凝，C3F8或硅油填充。手术后随访9～122个月，平均随访时间51个月。观察视力以及视网膜解剖结构改善情况。结果末次随访视力提高者20只眼，占74．1％；维持不变者7只眼，占25．9％。平均视力提高至0．26±0．15。与治疗前平均视力比较，差异具有统计学意义（t=-6．320，P=0．000）。27只眼视网膜解剖结构复位良好，视网膜平伏。OCT检查显示，黄斑劈裂平均面积（0．29±0．21）mm2，较治疗前黄斑劈裂平均面积显著缩小（t=10．358，P=0．000）；黄斑微囊样病变得到明显的改善。随访期间4只眼出现并发症，占14．8％。其中，2只眼分别在手术后6、8个月并发增生性玻璃体视网膜病变伴牵拉性视网膜脱离；1只眼在手术后4个月出现并发性白内障；1只眼在手术后15个月因新发视网膜裂孔而发生玻璃体积血。给予再次手术治疗后，4只眼视网膜复位良好。结论玻璃体视网膜手术能有效提高XLRS患者视力，恢复视网膜解剖结构，获得良好的治疗效果。

Objective To evaluated the efficacy of vitreoretinal surgery for X-linked retinoschisis （XLRS） and its complications. Methods Twenty-one XLRS patients （27 eyes） with retinal detachment or vitreous hemorrhage who were treated by vitreoretinal surgery were enrolled in this study. There were microcystis-like splitting in all the eyes. The mean visual acuity was 0.11 ±0.09 and the mean area of macular splitting was （1.09±0.56） mm2. Among the eyes, there were 12 eyes with rhegmatogenous retinal detachment, five eye with traction retinal detachment, six eyes with vitreous hemorrhage and four eyes with retinal detachment and vitreous hemorrhage. All the patients underwent a standard three-port pars plana vitrectomy. Internal limiting membrane peeling, laser photocoagulation, and C3F8 gas or silicone oil tamponade were carried out in different condition. The follow-up was 9 122 months （average 51 months）. The preoperative visual acuity and anatomic structure of retina were observed. Results The mean visual acuity at last visit was increased to 0.26±0.15, the difference was significant （t=-6. 320, P=0. 000）. It improved in 20 eyes （74.1 %）, remained unchanged in seven eyes （25.9% ）. The retina remained attached in 27 eyes. The mean area of macular splitting was decreased to （0.29±0.21） mm2, the difference was significant （t=10. 358, P=0. 000）. The complications were found in four eyes （14.8%） which including two eyes with proliferative vitroretinopathy and traction retinal detachment six and eight months after surgery, one eye with cataract four months after surgery, and one eye with vitreous hemorrhage 15 months after surgery. The retina remained attached in these four eyes after reoperation. Conclusion Vitreoretinal surgery can significantly improve visual acuity, resume the anatomic structure of retina.