硅油在现代玻璃体视网膜手术中的应用

Usage of silicone oil in modern vitreous surgery

目的 通过回顾性分析及比较了解硅油在现代玻璃体手术中的应用及硅油对增殖性玻璃体视网膜病变 (pro-liferative vitreoretinopathy,PVR)及增殖性糖尿病视网膜病变 (proliferative diabetic retinopathy,PDR)中的疗效。方法 分析 1993年 1月～ 1997年 12月在国立名古屋医院接受玻璃体切割手术治疗的患者 ,选出应用硅油的 112例 ;并选择其中合适的 80眼进行进一步分析。结果 与过去相比硅油在 PVR和 PDR中的指征有不同程度的变化。在 2 8.2个月的随访后 ,PVR组取得了 73.5 %的视网膜复位率 ,同时大部分患者在术后能获得视力改善或保持原有的视力 ;PDR组则仅维持术前视力 ,且在长期随访之后 ,视力有明显下降 ;另一方面硅油在虹膜新生血管的眼中未能取得预期的疗效。术后并发症方面 ,PDR组仅在视网膜前出血方面多于 PVR组。结论 硅油在复杂性 PVR及 PDR的治疗中发挥着重要的作用 ,硅油的指征在近年已有所变化 ;同时在某些方面硅油的疗效有待进一步研究 ;尽管采取了多种防治手段 。

Objective To analyze and find out the application as well as the efficacy of silicone oil(SO) in modern vitreous surgery.Methods Retrospectively, we studied the cases received vitrectomy at Nagoya National Hospital from January,1993 to October,1997, and picked out the 112 cases by whom silicone oil was used. From these cases, 80 eyes suitable for further analysis were picked out and studied.Results The indication in proliferative vitreoretinopathy(PVR) and proliferative diabetic retinopathy(PDR) had changed in recent years. At the end of the 28.2 months' follow up, 73.5% of the retina in the PVR group was attached, and in most patients visual acuity got improved or remained the same; while in PDR patients most only maintained their vision, and the vision decreased in the long term. The patients with rubeosis did not have a favorable outcome. Postoperative complications occurred, the occurrence of the complications didn't differ between the two groups except that PDR group had more preretinal hemorrhage.Conclusion Silicone oil is useful in the management of complicated PVR and PDR cases. There is some change in the indication of SO, and its effect in certain patients still needs to be determined. Also although cares have been taken, complications still occur.