充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离

Clinical observation of pneumatic retinopexy on the treatment of residual retinal detachment afterscleral buckling

【摘要】目的观察充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离的疗效。方法回顾分析我科经充气性视网膜固定术治疗巩膜扣带术后残留视网膜脱离13例（13眼）孔源性视网膜脱离或合并增生性玻璃体视网膜病变（PVR），其中PVRA级3眼，B级6眼，C1级3眼，C2级1眼；黄斑部脱离4眼。眼轴长度21．45-28．47mm。前次手术采用单纯巩膜外加压8眼，环扎联合加压3眼，环扎联合加压、注气2眼。患眼于本次术中玻璃体腔内注入纯全氟丙烷（C3F8）气体0．5-1．0ml，术后严密观察，保持适当体位，确保气泡封闭裂孔。结果手术后随访2-13月，12眼视网膜完全复位。1眼因PVR进展视网膜下液增多，视网膜未复位，后行玻璃体手术。手术后9眼视力提高，3眼视力不变，1眼视力下降。结论巩膜扣带术后残留视网膜脱离可以通过充气性视网膜固定术获得视网膜解剖复位，视力改善。

Objective To evaluate the therapeutic effect of pneumatic retinopexy technique on re- sidual retinal detachment after a seleral buckling procedure. Methods The serial clinical data of 13 pa- tients （ 13 eyes） with residual retinal detachment after a scleral buckling procedure in our department were retrospectively reviewed. They were treated with pneumatic retinopexy. The duration of the disease ranged from 2 weeks to 2 months. All the patients were with rhegmatogenous retinal detachment or combined with various proliferative vitreoretinopathy （PVR）, including stage A of PVR in 3 eyes, stage B in 6 eyes, stage C1 in 3 eyes and stage C2 in 1 eye. Maeular detachment was found in 7 eyes. The axial length of the opera- ted eyes ranged from 21.45 to 28.47 ram. In prior surgeries, seleral buckling was performed on 8 eyes, buckling combined with cerclage on 3 eyes and buckling combined with cerclage and intravitreal gas injection on 2 eyes. Filtered perfluoropropane （ C3Fs ） gas, 0.5 to 1.0 ml in volume, was injected into the vitreous 3.5 mm from the limbus. All the patients were hospitalized, frequently visited by the performing doctors, and instructed how to position themselves properly so that the gas bubble continually covered the break. Re- suits The follow-up duration was from 2 months to 13 months. Retina was completely reattaehed in 12 eyes. The subretinal fluid increased after the operation with unreattached retina and vitrectomy was performed in 1 eye due to the development of PVR. After the first operation, the visual acuity improved in 9 eyes, kept no change in 3 eyes, and decreased in 1 eye. Conclusion After pneumatic retinopexy treatment, reattaeh- ment of retina and improvement of visual acuity can be achieved partly in some patients with residual retinal detachment after a scleral buckling procedure.