全玻璃体切除术治疗小儿视网膜脱离的疗效观察

Therapeutic effects of total vitrectomy surgery for pediatric retinal detachment

目的观察全玻璃体切除术治疗小儿视网膜脱离的临床效果。方法回顾性病例系列研究。收集2006年1月至2010年12月40例（40只眼）行全玻璃体切除术治疗小儿视网膜脱离患者的临床资料，对其病因、眼底情况、手术过程、预后（术后视力、眼压、视网膜复位情况）、术中及术后并发症等进行回顾性分析。结果40例患儿原发疾病为先天性或发育性眼部结构异常16例、裂孔性视网膜脱离11例、眼外伤9例、牵拉性视网膜脱离3例、急性视网膜坏死综合征1例；手术后随访时间3～48个月，平均13．5个月；一次手术视网膜复位33例（82．5％），最终视网膜复位39例（97．5％），剩下1例放弃二次手术；手术后最佳矫正视力≥0．4者3例，0．06～0．3者14例，≤0．05者23例，与术前相比差异具有统计学意义（P〈0．05）；术后继发青光眼5例（均可用降眼压眼药水控制）。结论全玻璃体切除术可以完全切除玻璃体，降低巩膜穿刺孔并发症、有效预防增生性玻璃体视网膜病变的发生、促进睫状体功能的恢复，提高小儿视网膜脱离手术的成功率。

Objective To observe the efficacy of the pediatric retinal detachment using the to- tal vitrectomy surgery. Methods It was a retrospective case series study. Forty cases were pediatric patients with retinal detachment treated from January 1, 2006 to December 31, 2010 with total vitrectomy. The causal diseases, fundus, surgery process, intraoperative and postoperative complications were observed. The visual acuity before and after surgery was comparatively analyzed. Results Ac- cording the causal diseases, 16 cases had Congenital or developmental anomalies, 11 cases were rhegmatogenous retinal detachment, 9 cases were traumatic retinal detachment, 3 cases were traction retinal detachment and another was acute retinal necrosis syndrome. They were followed-up ranged from 3 to 48 months （13.5 months in average）. Thirty three （82.5%） eyes achieved retinal reattach- merit primarily and thirty nine eyes （97.5%） achieved retinal reattachment finally, another abandon second surgery. The final corrected visual acuity ≥0.4 was in 3 cases, 0.06-0.3 was in 14 cases and ≤0.05 was in 23 cases, which had significant difference contrasted to that of pre-operation （P 〈 0.05）. Five eyes were secondary glaucoma after the operation, but all were controlled by anti-glauco- ma medical drops. Conclusions Ttie technology of total vitrectomy can remove the vitreous body completely, reduce the sclerotomy-related complications, prevent proliferative vitreoretinopathy appear- ance and promote ciliary body to secrete aqueous fluid, increase the rate of surgery success.