保留晶状体的玻璃体视网膜手术治疗巨大视网膜裂孔

Lens-sparing vitreoretinal surgery for treatment of giant retinal tears

目的 探讨保留透明晶状体的玻璃体视网膜手术治疗伴有增生性玻璃体视网膜病变 (pro-liferative vitreoretinopathy,PVR)的巨大视网膜裂孔 (giant retinal tears,GRT)的手术方法及效果。 方法 对 1997年 7月至 1999年 7月间 30例 GRT患者的 31只患眼作回顾性分析。手术方法包括三通道睫状体平部玻璃体切割、膜剥离、视网膜切开与切除、全氟萘烷使用、眼内激光光凝、硅油或 C2 F6 气体填充。术中2 8只眼保留透明晶状体 ,术后追踪时间 11～ 34个月 (平均 12 .5个月 )。 结果 GRT视网膜完全解剖复位2 9只眼 ,部分复位 1只眼 ,有效率为 96 .8%。硅油填充 2 7只眼 ,平均 6 .0个月后行硅油取出 ,追踪 6～ 19个月 ,2 6只眼视网膜全部复位 ,1只眼失败。3只眼行白内障手术摘除 ,最终保留晶状体 2 5只眼 ,其中并发晶状体后囊轻度混浊 16只眼。 2 4只眼术后视力提高 ,占 77.4% ,最好的矫正视力 0 .4。 结论 保留晶状体的玻璃体切割联合应用全氟萘烷液体及硅油填充可有效的提高伴有 PVR的 GRT手术成功率及视力。

Objective To evaluate the effect of vitreoretinal surgery with lens sparing technique in treating the detachment with giant retinal tear(GRT) associated with proliferative vitreoretinopathy(PVR). Methods Thirty one consecutive eyes with GRT underwent vitrectomy were analysed retrospectively. Operative techniques included peeling of pre retinal membrane, injection of perfluorodecalin liquid, retinotomy and retinectomy,endolaser,and silicon oil or C 2F 6 gas tamponade. Lens sparing vitrectomy was performed in 28 phakic eyes. Follow up period ranged from 11 to 34 months. Results Anatomic retinal attachment was achieved intraoeratively in 29 eyes. In 16 eyes of 28 eyes with postoperative cataract formation,3 eyes underwent cataract surgery with or without intraocular lens implantation. The corrected final visual acuity ranged from 0.4 to 0.01. Conclusion Most phakic eyes of retinal detachment with GRT PVR can be successfully operated on with an outcome of improving the visual acuity by using techniques of lens sparing vitrectomy, perfluorodecalin liquid and silcone oil tamponade.