孔源性视网膜脱离伴脉络膜脱离的手术治疗

Operation on the rhegmatogenous retinal detachment with choroidal detachment

目的 :探讨不同的手术方式对伴脉络膜脱离 (脉脱 )的孔源性视网膜脱离病例的预后影响。方法 :139例 140眼中 级膜 5 7眼 ( 40 .7% ) , A级膜 6 2眼 ( 44 .3% ) . B级膜 2 1眼 ( 15 .0 % )。 6 4眼行环扎加压手术 ( scleral buckling surgery,SB) ,76眼行闭合式玻璃体切除手术 ( closed virteous surgery.CV)。结果 :术后随访时间均大于 3月 ,最长达 2年 ,平均 3.7月 ,一次手术复位 10 9眼 ( 77.9% ) ,最终复位率 89.3% ( 12 5 / 140 )。 级膜中 SB、CV一次手术复位率分别为 82 .1%、 94.4% ( P>0 .0 5 ) ,其中裂孔大小合计 >3PD的 SB、CV一次手术复位率分别为 5 8.3%、 92 .3% ( P<0 .0 5 ) ; A级膜中 SB、CV一次手术复位率分别为 6 4.0 %、 86 .4% ( P<0 .0 5 ) ; B级膜均采用 CV手术 ,一次手术复位率 5 7.1%。结论 :对于膜形成不严重的 级膜行 SB手术比较合适 ,但裂孔合计 >3PD的宜行 CV手术 ,对于 A级膜及以上的行

Object:To inpuire into the effect of different surgical procedures on the prognosis of retinal detachment (RD)with choroidal detachment (CD).Methods:In 140 eyes of 139 patients,with membrane grade Ⅱ were 57 eyes(40 7%),with membrane gradeⅢA were 62 eyes(44 3%),with membrane grade ⅢB were 21 eyes(15 0%).64/140eyes undergoing scleral buckling surgery (SB),76/140 eyes were treated with closed witreous surgery(CV).Results:Follow up time was longer than 3 months,the longest time was 2 years and the mean time was 3 7monthes.109 eyes(77 9%)got retinal reattachment after only one surgery,and a final anatomic success was achieved in 89 3%(125/140).In membrane grade Ⅱ,the success rates of SB、CV after only one surgery were 82 1% and 94 4%(P>0 05).Among the cumulative break area larger than 3 optic disks(PD),they were 58 3% and 92 3% (P<0 05).In membrane grade ⅢA,they were 64 0%and 86 4%(P<0 05).In membrane grade ⅢB,21/21(100%)eyes were performed with CV,the succeed rate after one surgery was 57 1%.Conclusions:It was better for membrane grade Ⅱ with unserious prolifrative to be performed with SB.At the mean time,it was concluded that for the cumulative break area with which lager than 3PD CV should be better.So in membrane grade ⅢA or higher,CV was the best choice.