玻璃体切除联合硅油重水置换治疗大范围锯齿缘断离视网膜脱离

Combined vitrectomy and heavy water-silicone off exchange for retinal detachment with giant dialysis of ora serrata

目的观察23G玻璃体切除联合硅油重水置换及视网膜光凝治疗大范围锯齿缘断离视网膜脱离的临床效果。方法对大范围锯齿缘断离视网膜脱离20例（20眼）进行23G玻璃体切除联合硅油重水置换及视网膜光凝，对视网膜复位情况、视力、眼压、手术并发症等进行随访观察。结果出院前20眼视网膜全部复位，术后随访1～24个月，一次手术视网膜复位17眼，复位率85．00％，其中3眼轻度PVR及局部小裂孔行激光加固封闭；另3眼术后增生性玻璃体视网膜病变（PvR）而致视网膜脱离，再次手术复位。术后一过性高眼压5眼，白内障3眼，视网膜前膜3眼，包括黄斑前膜1眼及视网膜裂孔2眼。结论23G玻璃体切除联合硅油重水置换及视网膜光凝治疗大范围锯齿缘断离视网膜脱离具有创伤小，手术效率高，术后视网膜复位率高及并发症少等优点；术中彻底切除基底部玻璃体，彻底剥除视网膜前及下方增生机化，可以减少PVR发生，提高手术成功率。

Objective To observe the clinical efficacy of 23-gauge vitrectomy combined with heavy water-silicone oil exchange and photocoagulation for retinal detachment with giant dialysis of ora serrata. Methods Twenty eyes of 20 cases of retinal detachment with giant dialysis of ora serrata were treated with combined 23 G-minimally invasive vitrectomy and heavy water-silicone oil exchange and photocoagulation. The postoperative intraocular pressure （IOP）, visual acuity, best corrected visual acuity, success rate and complications were followed up. Results The retinas were completely reattached in all eyes. All cases were followed up for 1-24 months, 17 of 20 cases （85.00%） achieved retinal reattachment after single surgery, among them 3 eyes were treated with photocoagulation to enclose the area of mild PVR and small retinal tears. Three of 20 cases achieved retinal reattachment after twice surgery. The postoperative temporary high IOP occurred in 5 eyes, cataract occurred in 3 eyes, macular epiretinal membrane in 1 eye, epiretinal membrane in 2 eyes and retinal tears in 2 eyes. Conclusion Combined 23-gange vitrectomy with heavy water-silicone oil exchange and photocoagulation for retinal detachment with giant dialysis of ora serrata can simplify operational procedure, shorten surgical time and decrease complication. To improve the therapeutic efficacy,the complete vitrectomy is recommended including removing the vitreous base and peeling the epiretinal and subretinal membrane.