儿童孔源性视网膜脱离手术治疗特点及疗效分析

Evaluation of treatment for retinal detachment in juveniles

目的 探讨儿童孔源性视网膜脱离手术治疗特点及疗效。方法 对采用不同手术方法治疗的儿童孔源性视网膜脱离患者 10 8例 (116只眼 )进行临床效果分析。结果 2 1只眼行巩膜外加压术 ,1次手术视网膜复位 19只眼 ,术后视力≥ 0 0 2者 14只眼。 97只眼行玻璃体切除术 ,1次手术视网膜复位 5 8只眼 (5 9 8% ) ,最终视网膜复位 83只眼 (85 6 % ) ,术后视力≥ 0 0 2者 6 4只眼 (6 6 0 % )。术中使用膨胀气体填充 11只眼 ,1次性视网膜复位 7只眼 ,术后视力≥ 0 0 2者 5只眼。使用硅油填充 89只眼 ,1次性视网膜复位 5 1只眼 (5 7 3 % ) ,最终视网膜复位 76只眼 (85 4% ) ,术后视力≥ 0 0 2者5 9只眼 (6 6 3% )。结论 儿童孔源性视网膜脱离的治疗首选巩膜外加压术。玻璃体切除者 ,硅油作为眼内填充物较膨胀气体具有更大的优越性。视网膜切开术是严重增殖性玻璃体视网膜病变者视网膜复位的有效方法 ,但应慎重选择手术对象。

Objective To assess the effectiveness of different surgeries for retinal detachment in juveniles. Methods A retrospective analysis of the clinical therapeutic effects of various surgical treatments on 108 cases (116 eyes) in the age range of 3 14 years (mean, 9 6 years) was performed. Results Twenty one eyes underwent scleral buckling procedure, and the retina was reattached in 19 eyes primarily. Fourteen eyes obtained post operative visual acuity ≥0 02. Ninety seven eyes underwent vitrectomy, 58 (59 8%) eyes achieved retinal reattachment primarily and 83 eyes (85 6%) achieved retinal reattachment finally. Among them, retinal reattachment occurred in 7 of 11 gas filled eyes, and the post operative visual acuity ≥0 02 in 5 eyes; and the reattachment occurred in 51 (57 3%) of 89 silicone oil filled eyes, requiring only the primary repair. Of the silicone oil filled eyes, 76 (85 4%) eyes achieved retinal reattachment finally. Fifty nine (66 3%) silicone oil treated eyes had visual acuity ≥0 02 compared with 45 5% in long acting gas treated eyes. Conclusions Scleral buckling is a beneficial method in treatment of retinal detachment in juveniles. Vitrectomy should be considered for complicated retinal detachment. There is an advantage favoring silicone oil tamponade in achieving retinal reattachment. Retinotomy is a useful procedure for the retinal reattachment in eyes with severe proliferative vitreoretinopathy, however, it is necessary to be careful in selection of cases to undergo such a procedure.