大范围松解性视网膜切开和切除治疗复杂性视网膜脱离

Large relaxing retinotomy and retinectomy for complicated retinal detachment

目的 评价大范围 (≥ 180°)视网膜切开和切除术治疗复杂性视网膜脱离的结果。方法 回顾性分析 38例行此手术并联合硅油充填的病例 ,其中视网膜切开范围在 180°～ 36 0°者 2 2例 ,36 0°视网膜切开者 16例。 38例中 16例已行硅油取出术。结果 术后随访 3～ 42个月 ,平均 14个月 ,视网膜复位 33例 (86 .8% ) ,视力较术前提高 31例 (81.6 % ) ,不变 5例 ,下降 2例 ,12例 (31.6 % )≥ 0 .0 2 ,最佳矫正视力0 .3。取硅油前低眼压 2例 (5 % ) ,青光眼 4例 (10 .5 % )。取油后视力提高 3例 ,不变 11例 ,下降 2例。低眼压 5例 ,占全部取硅油病例 31.3% .36 0°视网膜切开组已取硅油 8例 ,4例发生低眼压 (5 0 % )。结论 大范围松解性视网膜切开和切除联合硅油充填术不失为一种经常规玻璃体视网膜手术无法治疗病例的有效补救措施。由于取硅油后低眼压发生率较高 ,故应尽量推迟取油时间。

Objective To evaluate the outcome of treating complicated retinal detachment (CRD) with the large retinotomy and retinectomy. Methods Thirty eight cases of CRD which had undergone large retinotomy and retinectomy combined with silicone oil tamponade were analyzed retrospectively, including 22 cases of equal to or larger than 180° and less than 360°, 16 cases of 360° retinotomy.Sixteen of 38 cases had undergone silicone oil removal (SOR).Results After being followed up for 3 to 42 months (mean 14 months), 33 cases (86.8%) achieved retinal reattachment. Visual acuity (VA) was improved in 31 cases (81.6%), unchanged in 5 cases, and decreased in 2 cases,≥0.02 in 12 cases. The best correct VA reached 0.3 in one case. The complication before SOR included 2 cases of hypotony (5%), 4 cases of secondary glaucoma (10.5%). After SOR, the VA was improved in 3 cases, unchanged in 11 cases, decreased in 2 cases. Five of 16 cases which had undergone SOR developed hypotony (31.3%). Four of 8 cases of 360° retinotomy which had undergone SOR developed hypotony (50%). Conclusions Large relaxing retinotomy combined with silicone oil tamponade may be an effective remedy for CRD when conventional vitreoretinal surgery failed. Because of higher complication of hypotony after SOR, we should delay the time of SOR.