视网膜切开及切除术在重度增生性玻璃体视网膜病变术中的临床应用

Clinical observation for retinotomies and retinectomies in the treatment of proliferative vitreoretinopathy

目的探讨视网膜切开及切除术在重度增生性玻璃体视网膜病变手术中应用的选择及疗效。方法回顾性分析2010年2月至2012年12月在广州军区武汉总医院眼科就诊的67例（67只眼），在玻璃体手术中曾行视网膜切开及切除的重度增生性玻璃体视网膜病变（proliferative vitreoretinopathy，PVR）患者的临床资料。67例患者中，原发性视网膜脱离22例，外伤性视网膜脱离27例，复发性视网膜脱离12例，视网膜坏死6例。PVR分期均属D期，其中D3期34例，占50．8％（34／67）。结果所有患者术后视网膜均得到复位，视力均有不同程度的提高，视力〉0．05者31例，占46．3％（31／67），术后术后随访3～24月（平均8月），59例视网膜平复，8例复发视网膜脱离，其中4例经再次手术后视网膜复位；另4例未再手术。结论在玻璃体手术中适时采用视网膜切开及切除技术可以提高重度增生l生玻璃体视网膜病变患者玻璃体手术的成功率。

Objective To evaluate the therapeutic effects of retinotomy and retinectomy for proliferative vitreoretinopathy. Methods A retrospective survey was done in 67 patients （67 eyes） with proliferative vitreoretinopathy （PVR） who underwent vitrectomy combined with retinotomy and retinectomy. Twenty-two eyes were primary retinal edtachment, 27 eyes were injury retinal detachment, and 12 eyes were recurrent retinal detachment. All of these cases were at stage D, 50.8% of them were stage D3. Results Retinal attachment was obtained and visual acuity was improved in all cases. After being followed up for 3 to 24 months （mean 8 months）, 59 cases achieved retinal reattachment, and 8 cases recurred, 4 cases achieved retinal reattachment after reoperation, other 4 case without surgery. Conclusions Retinotomy and retinectomy are beneficial for the success of proliferative vitreoretinopathy.