头位油液交换法处理外伤性巨大视网膜裂孔

Management of traumatic giant retinal tear with adjusting head posture and fluid-oil exchange

目的:介绍一种玻璃体切割术中处理外伤性巨大视网膜裂孔 (traumaticgiantretinaldetachment ,TGRT)的方法。方法 :适应症为裂孔范围≤ 180° ,PVR较轻的TGRT。将灌注头置于无裂孔的象限 ,行玻璃体切割术后 ,在裂孔所在方向留一睫状体平坦部切口 ,通过头位调整及眼球旋转 ,使此切口逐渐处于眼球最低位置 ,从灌注头注油后先在无裂孔区形成油泡 ,随着油泡扩大将视网膜逐渐展平复位 ,视网膜下液由裂孔中被逐渐压出 ,并从处于下方的睫状体平坦部切口中排出眼外。结果 :共用此法处理TGRT12例 ,术中视网膜全部复位。经 6～ 2 0个月随访 ,已取出硅油 10例 ,未次复诊 11例保持复位。结论 :在适应症范围内通过调整头位和油液交换是一种操练简便、效果确切。

Objective:To introduce a method for managing the traumatic giant retinal tear (TGRT) within vitrectomy. Methods:The indication of the method introduced here is TGRT≤180° and no severe PVR.The main points of the procedure are as follows.The infusion cannula was placed in the quadrant opposite to the tear.After vitrectomy,a pars plana incision in the position of TGRT was retained.Through adjusting the head position and turning the eye globe,the incision was positioned in the lowest level of the globe gradually.The posterior flap of the tear was pushed and pressed slightly with the vitrectomy probe or blunt needle,and was finally unfold and sink close to the pigment epithelium.When silicone oil was injected from the infusion cannula,the bubble firstly appeared in the area without the tear.Alone the bubble expanding,the retina was gradually reattached and subretinal fluid was pressed out from the tear and then drained out of eye from the retained pars plana incision in the lowest position. Results:TGRT were managed with this way in 12 case and all were reattached intraoperatively.After follow up of 6～12 months,silicone oil was removed from 10 eyes,the retina remained attached in 11 cases. Conclusions:Within the indication,it is a simply,effective and economical method for managing the TGRT with adjusting the head position and fluid-oil exchange.