最小剂量手术治疗裂孔源性视网膜脱离47例临床分析

Clinical analysis on minimum dose surgery for 47 cases of rhegmatogenous retinal detachment

目的探讨最小剂量手术方法治疗裂孔源性视网膜脱离的临床效果及适应证。方法对47例(47眼)裂孔源性视网膜脱离的患者采用单纯巩膜外垫压+冷凝手术,术中均不放液,其中男34例,女13例,右眼29例,左眼18例,年龄17～65岁。视力:指数～0.5。所有患者术前均散瞳后行眼底镜、间接眼底镜、三面镜详细检查眼底,并绘制眼底图。结果 47例患者中术后一次性复位40例,占85.1%;裂孔未完全封闭,形成鱼嘴,网膜下进液体4例,4例患者裂孔均位于下方,且术前视网膜隆起较高,行二次最小剂量手术,垫压物重新转移固定后均复位。发现新的裂孔1例。2例因发生PVR牵拉做了玻璃体切割手术后复位。术后裂孔补充光凝12例。结论在间接眼底镜下行最小剂量裂孔源性视网膜脱离手术具有损伤小、手术操作简单、术后效果好的优点,术前精确检查、裂孔定位及严格筛选病例是手术成功的关键。

Objective To evaluate the clinical effects and indications of the surgical treatment with the minimum dose to rhegmatogenous retinal detachment.Methods We treated 47 patients（47 eyes） with rhegmatogenous retinal detachment with scleral explant and condensation,and didn＇t draining the subretinal fluid in all patients.The patients include 34 males and 13 females,and 29 cases in right eye,18 cases in left eye.The patients aged from 17 to 65 years old.And the Vision was from CF to 0.5.All patients were treated with ophthalmoscope and indirect ophthalmoscope and three mirror contact lens after mydriasis before operation,and made the drawing of fundus image.Results There were 40 patients（85.1%） whose detached retina were recovered in one-time,and there were 7 cases whose holes of retina were not completely closed and looked like the fish-mouth,so drained the subretinal fluid.There were 7 cases whose holes in the bottom of retina,and the uplift of retina were very high before operation.They were treated with minimum dose once again,and the detached retina was recovered after the pads were re-transfered and fixed.A new hole was found in 1 case.2 cases were treated with vitrectomy because of PVR,and the detached retina was recovered finally.12 cases were treated with photocoagulation after operation.Conclusion The surgical treatment with the minimum dose to rhegmatogenous retinal detachment under the indirect ophthalmoscope endoscopy has the advantages of less damage,simple operation and better effects.The preoperative examination,accurate location of hole and strict selection of case are the key to successful operation.