术后不需低头位的玻璃体手术治疗黄斑裂孔性视网膜脱离

Vitreoretinal surgery with intraoular C_3F_8 tamponade for retinal detachment due to macular hole without face-down positioning

目的 探讨术后不需低头位的玻璃体手术疗效。方法 对 2 7例 (2 7只眼 )近视性黄斑裂孔视网膜脱离患者 ,经闭合式玻璃体切除、剥膜后气液交换 ,以 16 %C3 F8全玻璃体腔填充 ;3例同时行晶状体超声乳化吸出术 ,其中 2例植入人工晶状体 ,术后早期避免仰卧位 ,其他体位不受限。结果2 1例 (78%)患者术后不需低头位即获黄斑裂孔闭合、视网膜复位。另 6例分别因惰性气体吸收较快、视网膜黄斑白孔及视网膜下组织增生 ,而致黄斑裂孔未闭并伴下方视网膜脱离 ;其中 3例气泡吸收较快者于术后 10d改嘱低头位 ,2例获视网膜复位。随访时间 >6个月。 2 2例 (81%)保持视网膜平伏 ,黄斑裂孔愈合 ;视力≥ 0 1者 19例 ;主要并发症为晶状体混浊 (6 / 19)和一过性高眼压 (3/ 2 7)。结论术后不需低头位的玻璃体手术 ,并以 16 %C3 F8气体填充全玻璃体腔 ,治疗黄斑裂孔视网膜脱离的效果良好 ,尤其适用于老年或体弱患者。

Objective To evaluate the effectiveness of vitreoretinal surgery with 16% perfluoropropane (C 3F 8) tamponade without face-down positioning in treatment of retinal detachment due to macular hole. Methods Twenty-seven consecutive eyes in 27 patients with retinal detachment due to myopic macular hole underwent closed vitrectomy, membrane peeling, gas-fluid exchange with C 3F 8 tamponade in the whole vitreous chamber. In 3 eyes, phacoemulsification was performed, and 2 of them received intraocular lens implantation. Postoperatively, except avoiding the supine position, the body position was not restricted. Results Twenty-one cases (78%) obtained successful retinal reattachment without the postoperative face-down positioning. In another 6 cases, because of the relatively quick absorption of the gas, the white macular hole and the subretinal proliferation, the operation was not successful, the hole being not sealed and the retinal detachment at the lower part still existing. In the 3 cases with quick absorption of the gas, on the 10th day after the operation, the body position was changed into a face-down one. In 2 of them, the retinal reattachment occurred. After >6 months of follow-up, the retinal reattachment remain the same in 22 cases (81%), the macular hole was healed, and the visual acuity was elevated to ≥0.1 in 19 cases. The main complications were lens opacity in 6 cases (31%), temporary elevation of intraocular pressure in 3 cases (11%). Conclusion Use the methods for the treatment of macular hole and retinal detachment mentioned above may obtain relatively good therapeutic results, particularly suitable for senile and unhealthy cases.