Resight非接触广角镜下行25G玻璃体切割治疗Valsalva视网膜病变

Using 25G vitrectomy for the Valsalva retinal disease with the help of Resight non-contact wide angle lenses

目的观察Resight非接触广角镜下行25G玻璃体切割术治疗严重Valsalva视网膜病变的效果。方法回顾性分析2011年7月至2012年12月在南昌大学附属医院眼科应用Resight非接触广角镜下，行25G玻璃体切割术治疗8例8只眼严重Valsalva视网膜病变眼的临床资料。患者中男性6例，女性2例；年龄24-48岁，平均年龄35岁；右跟5只，左眼3只；最佳矫正视力为跟前手动至眼前指数；发病时间23-60天，平均42天；所有患者均经病史咨询和眼底荧光血管造影、眼底照相、眼科B超等检查，确诊为严重的Valsalva视网膜病变。患眼黄斑部均大面积视网膜前出血，经ND：YAG激光治疗或药物保守治疗积血未消退，而后接受在Resight非接触广角镜下行25G玻璃体切割术。手术方式为闭合三通道玻璃体切割术，术毕玻璃体腔未注射任何药物，也未使用任何填充物。术后随访观察2～12个月，平均8个月。结果在Resight非接触广角镜下用25G玻璃体切割手术治疗严重的Valsalva视网膜病变，手术时间最短10min，最长16min，平均手术时间为12min。术后视力均显著提高，末次最佳矫正视力3只眼为0．9，4只眼为1．0，1只眼为1．2；所有患者黄斑部出血完全消退，眼底荧光血管造影未发现明显异常；术后眼压均正常，术后2周内有1只眼出现轻度玻璃体混浊，1个月后消退，无视网膜脱离、并发性白内障等并发症发生。结论在Resight非接触广角镜下行25G玻璃体切割手术治疗严重的Valsalva视网膜病变，其广角系统及微创玻璃体切割系统的有机结合，能明显缩短手术时间，快速恢复视力，而且并发症少，是治疗严重Valsalva视网膜病变的安全、有效方法。

Objective To observe the effect of 25G vitrectomy for the serious Valsalva retinal disease with the help of Resight non-contact wide angle lenses. Methods Retrospectively analyzed the clinical data of 8 cases （8 eyes） with the serious Valsalva retinal disease using 25G vitrectomy with the help of Resight non-contact wide angle lenses. The 8 patients included 6 male and 2 fe-male, with the age of 24-48 years old （meanly 35 years）. In these 8 eyes, the right eyes were in 5, and the left in 3. The BCVA was hand movement to finger counting. The onset time was 23-60days, meanly 42 days. The diagnosis of the serious Valsalva retinal disease was made by histo-ry consulting, fundus fluorescence angiography, fimdus photography, ophthalmic B-ultrasound and so on. The epiretianl hemmorrhage was found in macular area of all eyes. The hemorrhage did not re-gress with the treatment of NAG or drug. Then, these patients underwent 25G vitreetomy with the help of Resight non-contact wide angle lenses. The entrance of vitrectomy was closed triple inci-sions. The vitreous cavity was not injected with any drug, not temponaded with any material. Fol-low-up time was for 2-12 months, meanly 8 months. Results The serious Valsalva retinal disease was underwent vitrectomy using 25G with the help of Resight non-contact wide angle lenses. The operation time was 10-16 minutes, meanly 12 minutes. The postoperative BCVA increased markedly. The last BCVA was 0.9 in 3 eyes, 1.0 in 4 eyes, 1.2 in leye. The intraocular pressure was normal postoperatively. The light vitreous opacity occurred in 1 eye after 1 week, and regressed after 1 month. Retinal detachment and complicated cataract did not occur in no one eye. Conclusions Vit-rectomy for the Valsalva retinal disease with the help of Resight non-contact wide angle lenses can increase visual acuity, shorten operation time, decrease complication because of the combination with the wide angle system and minimal invasion vitrectomy system. It is effective and safe for the treat- ment of serious Valsalva retinal disease.