合并脉络膜脱离的孔源性视网膜脱离患者的手术疗效分析

Surgical therapeutic results of rhegmatogenous retinal detachment associated with choriodal detachment

目的 探讨合并脉络膜脱离的孔源性视网膜脱离患者的手术疗效及其影响手术疗效的因素。方法 回顾 1996年 1月至 1998年 8月间 ,本院收治的 188例 (188只眼 )合并脉络膜脱离的孔源性视网膜脱离患者的临床资料 ,分析患者术前增生性玻璃体视网膜病变 (proliferativevitreoretinopathy,PVR)的分级、手术方式、术前糖皮质激素治疗等因素与手术疗效的关系。结果 本组患者手术治愈率为 83 0 % ,低于一般视网膜脱离的治愈率 ;PVR的A～B级手术治愈率为 89 6 % ,C1～C3 级为 84 1% ,D1～D3 级为 6 9 0 % ;PVR的C1～C3 级中 ,行玻璃体切除术者的手术治愈率高于行巩膜扣带术者 ;术前糖皮质激素使用者比未使用者手术治愈率高 ;糖皮质激素使用时间的长短与手术治愈率无关 ;巩膜扣带术者中 ,放液与不放液与手术治愈率无关。结论 合并脉络膜脱离的视网膜脱离患者 ,其视网膜脱离程度严重 ,PVR发展快 ,术前应及时给予糖皮质激素治疗 ,但不能延误手术时机。对PVR的A～B级、脉络膜脱离程度不严重的患者可行巩膜扣带术 ,尽量不放视网膜下液、不注气 ;对PVR的C级患者行玻璃体切除术是解决严重脉络膜脱离的有效方法 ,对脉络膜脱离程度较轻的患者也可行巩膜扣带术 ;

Objective To evaluate the effect of different factors on the prognosis of rhegmatogenous retinal detachment (RRD) associated with choroidal detachment (ChD). Methods One hundred and eighty eight eyes of 188 patients were studied retrospectively from Jan,1996 to Aug,1998. The clinical data, surgical management and follow up records were analyzed. Results The total successful rate of the surgery was 83 0%, lower than that of general RRD. In the eyes with proliferative vitreoretinopathy (PVR) A B, the rate was 89.6%, in the eyes with C 1 C 3 PVR, the rate was 84.1%, in D 1 D 3, 69.0%. In eyes with severe PVR the successful rate of vitrectomy was higher than that of scleral buckling alone. Administration of steroids before surgery resulted in high successful rate, but the length of time of the steroid treatment had no effect on the successful rate. In the eyes using scleral buckling alone, the drainage or without the drainage of subretinal fluid had no effect on the successful rate. Conclusions RRD associated with ChD has worse prognosis than general RRD. The administration of steroids before surgery is necessary, and the timing of surgery is also important. In eyes with light PVR and ChD, scleral buckling without drainage of subretinal fluid is the first choice, but in eyes with severe PVR and ChD, vitrectomy is a better choice.