三面镜视网膜裂孔定位联合外路显微手术治疗孔源性视网膜脱离的临床观察

Three-mirror lens localizing retinal breaks combined with external-route microsurgery for rhegmatogenous retinal detachment

目的观察术前三面镜裂孔定位联合外路显微手术治疗孔源性视网膜脱离的临床效果。方法回顾性分析2013年1月至2013年9月因孔源性视网膜脱离而做视网膜脱离外路显微手术的患者30例（30只眼）。术前用三面镜检查确定视网膜裂孔位置,作为手术中指导裂孔定位、术中放液和冷凝部位的的依据。手术时在显微镜直视下先预置环扎带和缝线,放视网膜下液,然后经巩膜外视网膜冷凝、垫压,最后核实裂孔、扎紧环扎带和眼内注气。术后随访6~12个月。结果在30例（30只眼）中,一次手术视网膜完全复位25只眼,手术成功率为83%。术后矫正视力,〈0.1者3例,0.1~0.3者9例,〉0.3者18例;视力提高者20例,不变者8例,下降者2例。无严重手术并发症发生。结论术前三面镜检查定位视网膜裂孔方法可靠,对视网膜脱离外路显微手术具有指导意义。而视网膜脱离外路显微手术具有操作简单、方便、治疗效果良好等优点。

Objective To observe the clinical efficacy of three-mlrror lens localizing retinal breaks combined with extemal-reute micresurgery for rbegmatogenous retinal detachment. Methods Thirty cases （ 30 eyes ） with rbegmatogenous retinal detachment （ RRD ） were treated with external-route micresurgery from January to September in 2013. The locations and distance of retinal breaks were estimated by three-mirror lens preoperatively as the guide for retinal localization drain- age of subretinal fluid and flee.zing during operations. The silica gelpiece and/or buckling bands were pre-placed, and then drainage of subretinal fluid tinal cryotherapy and checking on the retinal breaks, and intraocular gas injection were per- formed under surgical microscope. All patients were followed for 6-12 months after surgery. Results Retinal reattachment was achieved in 25 cases. The success rate was 83%. The best corrected visual acuity was 〈 0. 1 in 3 eyes, between 0.1 ~0.3 in 9 eyes, and 〉0.3 in 18 eyes. The final visual acuity improved in 20 eyes, remains unchanged in 8 eyes, and declined in 2 eyes. There were no serious complications found in all cases. Conclusion Localizing retinal breaks preoper- atively with three-mirror lens is a dependable method to provide guidance for external approach surgery to treat RRD. The extemal-reute microsurgery is simple, convenient and effective.