360度眼内光凝联合全氟化碳液硅油交换治疗巨大裂孔性视网膜脱离的临床研究

360 degrees intraocular photocoagulation combined with perfluorocarbon liquid-silicone oil exchange for retinal detachments with giant retinal tear

目的 探讨360度眼内光凝联合全氟化碳液硅油交换治疗巨大裂孔性视网膜脱离手术效果。方法 巨大裂孔性视网膜脱离患者15例15眼均行玻璃体切割、手术显微镜直视下360度眼内光凝联合重水硅油交换治疗,其中4例因合并有白内障联合行白内障摘除;术后观察视网膜复位情况、视力及并发症。结果 术后随访6~24个月,平均14.3个月,13例视网膜完全复位（86.7%）;视网膜在术后3周至3个月因术后增生性玻璃体视网膜病变的形成导致视网膜裂孔开放而发生再脱离2例（13.3%）;完全复位者有12例取出硅油,其中有2例复发;术后6个月视力较术前好转12例,不变2例,仅有1例下降,术后盲目率（26.7%）与术前（80%）比较有显著性下降（χ2=8.571,P〈0.05）。术中未行白内障摘除的11例中术后发生白内障6例,一过性高眼压5例,视网膜出血1例。结论 应用360度眼内光凝联合全氟化碳液硅油交换治疗大于180度巨大裂孔性视网膜脱离,术后可得到满意的视网膜复位率及脱盲率。

Objective To explore the clinical efficacy of 360 degrees intraocular photocoagulation combined with perfluorocarbon liquid-silicone oil exchange on retinal detachments with giant retinal tear. Methods Fifty cases （ 15 eyes） of retinal detachments with giant retinal tear were enrolled in our study. All cases underwent pars planar vitrectomy （PPV） ,360 degrees intraocular laser photocoagulation combined with perfluorocarbon liquid-silicone oil exchange under operation microscope, four of them combined with cataract extraction due to cataract concurrently. The reattachment rate, visual acuity and complications were examined. Results After operation,the mean follow-up period was 14.3 months （ range 6 to 24 months）. Thirteen of 15 eyes （86.7%） achieved retinal reattachment after the initial surgery. Owing to postoperative PVR induced retinal holes remained opened, 2 of 15 eyes （13. 3% ） were redetach under silicone oil tamponade after the surgery 3 weeks to 3 months. Among 12 cases which removed silicone oil, recurrent retinal detachment occurred in 2 cases. Postoperative acute vision improved in 12 cases, remain unchanged in 2 cases and decreased in 1 case. As compared with preoperative blindness rate （ 80% ） , the postoperative blindness rate（26.7% ） was significantly decreased（ X2 = 10. 5263, P 〈 0.05 ）. Postoperative cataract was observed in 6 of 11 phakic eyes, ocular hypertension in 5 of 15 eyes and subretinal hemorrhage in 1 of 15 eyes. Conclusions PPV, 360 degrees intraocular photocoagulation combined with perfluorocarbon liquid-silicone oil exchange under operation microscope can achieve favorable6 anatomical and visual results in the treatment of retinal detachments with giant retinal tear.