玻璃体手术联合视网膜切开或切除治疗外伤复杂视网膜脱离

Vitrectomy combined with retinectomy or retinotomy for treatment of complicated traumatic retinal detachment

目的分析玻璃体手术联合视网膜切开或部分切除治疗外伤性复杂视网膜脱离的手术效果。方法对116例（116眼）外伤复杂性视网膜脱离行玻璃体手术联合视网膜切开或部分切除，观察并分析临床效果。手术方式采用通过睫状体平坦部标准巩膜三通道行玻璃体切除、剥膜、视网膜切开或部分切除、过氟化碳液体使用、视网膜光凝、气体一过氟化碳液体交换、填充C3F8或硅油。116眼均采用视网膜切开或部分切除联合术。术后2～4周补视网膜光凝1次，观察3～6个月。结果116眼出院时均达到视网膜解剖复位并行眼底照相、验光存档，有效率达100％。视力〉0．05者87眼，占75％，最好视力达到0．6。增生性玻璃体视网膜病变视网膜再脱离5眼。结论在外伤复杂视网膜脱离行玻璃体切除联合视网膜切开或切除提高了视网膜解剖复位率特别是对视网膜增生增厚、僵硬、视网膜下线条等是一种重要手段，但视功能与疾病损伤程度、手术时机等相关。

Objective To analyze the surgical effect of complicated traumatic retinal detachment treated with vitrectomy combined with retinotomy or parts of retineetomy. Methods 116 cases （ 116 eyes） with complicated traumatic retinal detachment, were treated with vitreetomy combined with retinotomy or parts of retinectomy. The clinical effects were observed and analyzed. Operation methods were treated by un- dergone pars plana vitreetomy combined with the methods of vitrectomy membranee excision, retinotomy or parts of retinectomy, perfluorocarbon liquids , retinal coagulation of laser, exchange between gas and perflu- orocarbon liquids, silicon oil and C3Fs filling. Retinal coagulation of laser was performed one time 2-4 weeks after operation in each patient, the follow-up periods were 3-6 months. Results Retinal reattachment were attained in 116 eyes when leaving hospital, the photograph of the fundus and optometry were performed and archived. The effective rate was 100%. 87 cases （75%） had vision better than 0.5 and the best visual acu- ity reacheed O. 6. The retinal detachment recurred in five eyes because of proliferative vireoretinopathy. Conclusion Vitrectomy combined with retinotomy or parts of retinectomy is an effective way for treating complicated traumatic retinal detachment, which can improve the rate of retinal attachment, and is an impor- tant method for retinal proliferation and thickness, retinal rigid, subretinal stripe especially. But visual func- tion recovery is related to the retinal disease degree, operation opportunity and so on.