并发视网膜脱离葡萄膜炎的玻璃体手术治疗

Par-plana vitrectomy in the management of uveitis complicated with retinal detachment

目的:探讨对并发视网膜脱离葡萄膜炎施行玻璃体手术的治疗效果。方法:回顾性分析本院22例并发视网膜脱离葡萄膜炎患者的临床资料。患者均接受标准三切口玻璃体手术,联合眼内光凝,根据情况联合注气(C3F8)或硅油注入术,手术结束时,玻璃体腔内注射曲安奈德(triamcinoloneacetonidel,TA)。术后全身配合小剂量糖皮质激素治疗和(或)联合免疫抑制剂治疗。结果:术后随访3月至5年,22眼视网膜复位良好,21眼视力较术前有增进,1眼与术前无明显差别,但是视网膜平复,未见复发性视网膜脱离及明显的增生膜。结论:玻璃体手术联合激素是治疗并发视网膜脱离葡萄膜炎的有效方法。玻璃体腔硅油填充术后,注入适量TA,TA可以缓慢释放,相当于在玻璃体腔内注入缓释激素,有利于预防葡萄膜炎反复发作及增生病玻璃体视网膜病变的发生和发展。

Objective：To investigate the therapeutic value of vitrectomy for uveitis complicated with retinal detachment. Methods：Standard three-incision vitrectomy was performed on 22 patients （22 eyes） with uveitis complicated with retinal detachment,whose age ranging from 5 to 64 years old. In these 22 eyes, C3F8 or silicone oil intraocular tamponade was injected according to the different needs, and triamcinoloneacetonidel（TA） was injected before the finishing of surgery to reduce the degree of postperative inflamation. All patients were treated with systemic immunoppressive therapy after surgery and the uveitis was controlled. Results：Twenty-two eyes were followed up for three months to five years. Retinas of all cases didn＇t detached. Twenty-one eyes obtained better visual acuity and one eye was unchanged but without recurrent retinal detachment and obvious hyperplasia. Conclusion：Par-plana vitrectomy assisted by TA is an effective method for uveitis. Injection of TA after silicone oil intraocular tamponade can make TA release slowly, equivalent to slow release of hormone,which can prevent recurrent occurrences of uveitis as well as occurrence and development of hyperplasia vitreous retinopathy.