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第二次玻璃体手术治疗复杂性视网膜脱离的临床分析 被引量:5

Clinical analysis on treatment of complicated retinal detachment through secondary vitreous surgery
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摘要 目的 :研究第 2次玻璃体手术治疗复杂性视网膜脱离的手术预后 ,以探讨原手术失败的原因和再手术的经验与教训。方法 :选取我院确诊为孔源性 RD并进行第 2次玻璃体手术的患者 34例 (34眼 )。PVR分级 B~C2 级 7眼 ,C3级 11眼 ,D级 16眼。总住院次数 1~ 4次 ,平均 2 .2次。总手术次数 2~ 7次 ,平均 3.5次。 2次玻切手术时间间隔 11~ 2 5 7天 ,平均 81.1天。第 2次玻璃体手术中尽量切除残余的玻璃体皮质 ,剥膜 ,部分患者视网膜切开 ,去除晶体 ,或结合采用环扎加压。封闭裂孔主要在眼内进行 ,采用全氟化碳液体下光凝、电凝或冷凝 ,部分患者采用直视下眼外冷凝。术毕采用 C3F8或硅油进行眼内填充。术后随访至少 6个月。结果 :再手术原因 :PVR发展合并有原孔未封和新孔产生占 76 .5 % ;单纯 PVR发展占 17.7% ;原孔未封和新孔产生的占2 .9% ;全氟化碳液体入视网膜下占 2 .9%。最终手术成功率为 73.5 %。术后视力提高占 6 4.7% ;视力不变占 14.7% ;视力下降占 2 0 .6 %。手术并发症有眼压升高、晶体混浊加重、前房出血、重水残留等。结论 :首次手术玻璃体切除不彻底 ,PVR再增生 ,裂孔封闭不良 ,新孔出现是手术失败的主要原因。再次进行玻璃体手术时 ,应彻底清除 PVR,恢复视网膜活动度 ,选择合适的封孔方法和? Objectives:We study on the prognosis of complicated retinal detachment surgery to probe into the cause of failure and draw the experience of secondary vitreous surgery.Methods:Retinal detachment(34 cases,34 eyes)was performed secondary vitreous surgery.PVR grade:B~C 2 7 eyes,C 3 11 eyes,D 16 eyes.Total times of surgery was 2~7times(average 3 5).During of two vitrectomy was 11~257 days (average 81 1).Secondary vitrectomy was combined with membrane peeling,or sectioning,or lensectomy,or relaxing retinotomy,or using perfluorocarbon liquids,or scleral buckling.Laser,endodiathermy and cryopexy were used to close the retinal breaks.After surgery perfluoropropane and silicon oil were used as retinal tamponade.All the patients were followed up than 6 months.Resoults:The cause of failure was PVR developing combined with initial breaks unclosure or new breaks(76 5%),only PVR developing(17 7%),new and initial breaks(2 9%),perfluorocarbon liquids residued(2 9%).Final success rate of surgery was 73 5%.Visual acuity increased(64 7%),unchanged(14 7%),declined(20 6%).Complications were elevating intraocular tension,hyphema,iatrogenic retinal breaks,et al.Conclusions:PVR developing,holes unsealing,new holes are the main cause of initial vitrectomy failure.The keys of success of secondary vitrectomy are completely removing PVR,releasing the traction of retina,selecting appropriate methods of colsing retinal breaks,avoiding complications.
出处 《中国实用眼科杂志》 CSCD 2000年第10期608-610,共3页 Chinese Journal of Practical Ophthalmology
关键词 视网膜脱离 玻璃手术 增生性 玻璃体视网膜病变 Retinal detachment Vitreous surgery Proliferative vitreoretinopathy
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参考文献3

  • 1许迅,中华眼科杂志,1998年,34卷,247页
  • 2孙晓东,中华眼科杂志,1996年,32卷,6期,409页
  • 3许迅,中华眼底病杂志,1995年,11卷,175页

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