巩膜扣带术处理硅油填充眼并发下方视网膜脱离

Scleral buckling treatment of recurrent inferior retinal detachment in silicone oil tamponade eyes

目的探讨巩膜扣带术对玻璃体视网膜手术术后硅油填充眼下方视网膜脱离的影响。方法于2009年3月至2013年7月诊治的23例初次玻璃体视网膜术后1-9月，合并下方视网膜脱离的硅油眼，行巩膜扣带术，术中以240#硅胶环扎，以276#车轮硅胶置于下方4-8点及需要支持的玻璃体视网膜病变的部位；Logistic回归分析巩膜扣带术对不同时间、不同原因导致的复发视网膜脱离预后的影响；以及分析巩膜扣带术后视网膜复位率、并发症发生率及矫正视力的变化。结果巩膜扣带术后，18只眼（78．26％）视网膜再次复位，其中16只眼术后6—12月行硅油取出，随访观察9—21月，视网膜复位好。Logistic回归显示：初次玻璃体视网膜手术和巩膜扣带术的间隔时间和视网膜复位密切相关差异有统计学意义（Waldchi—square 5．040；P=0．025）；巩膜扣带术后视力提高2只眼，视力无变化14只眼，视力下降7只眼；术前术后视力比较，差异无统计学意义（P=1．000）。结论玻璃体视网膜手术术后，硅油填充眼发生的下方视网膜脱离，巩膜扣带术具有很好的视网膜复位作用，其作用和初次玻璃体视网膜手术和再次巩膜扣带术的间隔时间密切相关；早期的巩膜扣带术，有利于再次脱离的视网膜的复位。

Objective To evaluate the anatomic outcomes of scleral buckling （SB） in silicone oil （SO）-filled eyes with inferior retinal detachment （RD） in different retinal proliferation states and different postoperative periods. Methods Twenty-three patients who underwent SB surgery for inferior RD in SO-filled eyes were retrospectively reviewed. SB involved a 2.5mm encircling band, 7mm silicone strip for the inferior quadrant, with/or without external subretinal fluid （SRF） drainage, and pars plana SO aspiration. A logistic regression model was constructed with anatomic success after SB as the dependent variable and with interval between PPV and SB, reasons for recurrences （anterior PVR）, et al. as independent variables. Anatomic reattachment of the retina and best-corrected visual acuity （BCVA） were measured. Results Eighteen eyes （78.26%） attained anatomic retinal attachment at last examination. SO removal was performed in 16 eyes after SB. Five eyes received revit- rectomy and relaxing retinectomy. Logistic regression showed that the interval between primary vitrectomy and SB was strongly associated with anatomic success （Wald chi-square 5.040; P =0.025）. BC- VA improved or stabilized in 16 eyes. Conclusions Inferior RD in SO-filled eyes can be treated with SB surgery, with/or without external SRF drainage, and/or pars plana SO aspiration, with satis- factory anatomic outcomes in eyes with perisilicone proliferation and eyes with anterior PVR in early postoperative periods.