超声乳化白内障吸除联合人工晶状体植入手术后视网膜脱离的手术效果

Surgical outcomes of retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation

目的观察超声乳化白内障吸除联合人工晶状体（IOL）植入手术后视网膜脱离（RD）的手术效果。方法回顾分析超声乳化白内障吸除联合IOL植入手术后发生RD并接受手术治疗的38例患者的临床资料。所有患者手术前常规行视力、裂隙灯显微镜、直接或间接检眼镜、A或B型超声、光相干断层扫描检查确诊。男性21例21只眼，女性17例18只眼。年龄42～83岁，平均年龄（57．4±11．2）岁。9例10只眼合并单纯黄斑裂孔性RD（MHRD）。根据RD范围、裂孑L位置及大小、增生性玻璃体视网膜病变分级等采取玻璃体切割手术或巩膜环扎手术或玻璃体切割联合巩膜环扎手术；MHRD患眼采用后巩膜加固手术。手术后随访3～26个月，平均随访时间（11．9土6．8）个月。结果36只眼1次手术后视网膜复位成功，成功率为92．3％。2只眼手术后RD复发并放弃手术；1只眼经3次手术后成功复位。超声乳化白内障吸除联合IOL植入手术后视力和RD手术后末次随访视力对比，视力下降36只眼，占92．3％；不变1只眼，占2．6％；提高2只眼，占5．1％。结论超声乳化白内障吸除联合IOL植入手术后RD一次手术复位率高，但视力预后不佳。

Objective To observe surgical outcomes and influencing factors of retinal detachment （RD） after phacoemulsification cataract extraction and intraocular lens （IOL） implantation. Methods The clinical data of 38 patients who underwent retinal detachment after phacoemulsification cataract extraction and intraocular lens implantation were retrospectively analyzed. All patients diagnosed via visual acuity, slitlamp microscopy, direct or indirect ophthalmoscopy, A or B-scan ultrasonography and optical coherence tomography （OCT）. There were 21 males （21 eyes） and 17 female （18 eyes）. The age was from 42 to 83 years, with the mean of （57.4 ±11.2） years. There were nine patients （10 eyes） with simple macular hole RD （MHRD）. Vitrectomy or scleral buckling or combined vitrectomy and scleral surgery were implemented according to RD range, the hole location and size, proliferative vitreoretinopathy （PVR） grading; simple MHRD eyes were treated posterior seleral reinforcement surgery. The follow-up was ranged from 3 to 12 months, with a mean of （11.9±6.8） months. Results The retina was reattached successfully through one operation in 36 eyes （92.3%）, two eyes failed because of a relapse after surgery, and one eye finally succeeded by the third times of surgery. There were two eyes （5.1%） with improved vision, one eye （2.6%） with stable vision, and 36 eyes （92.3%） with decreased vision. Conclusion The ratio of the reattachment by one operation for RD after phacoemulsification cataract extraction and intraocular lens implantation is high, but the final visual prognosis remains poorly.