不同手术方式治疗复杂视网膜脱离的对比观察

Efficiency of two different operation ways for a complex kind of retinal detachment

目的:对比玻璃体切除与玻璃体切除联合下方巩膜外垫压治疗复杂视网膜脱离的效果。方法:选取复杂视网膜脱离病例100例100眼,均病程≥1mo,合并下方周边视网膜裂孔,脱离区视网膜增殖、至少有一处皱襞。随机分成两组:治疗组50眼采取玻璃体切除联合下方巩膜外垫压治疗;对照组50眼采取单纯玻璃体切除治疗,比较两组视网膜解剖复位、矫正视力、术后1wk黄斑中央凹厚度及术后并发症情况。结果:治疗组视网膜解剖复位有49眼(98%),对照组视网膜复位42眼(84%),差异有统计学意义(χ2=4.2605,P<0.05);治疗组术后矫正视力:0.254±0.238,对照组术后最佳矫正视力:0.219±0.229,差异无统计学意义(t=1.8879,P>0.05);术后1wk,黄斑中央凹厚度:治疗组272±32.21μm,对照组316±33.46μm,差异有统计学意义(t=12.597,P<0.01);术后1wk内治疗组共有12眼(24%)眼压超过30mmH g,对照组有4眼(8%)眼压超过30mmH g,差异有统计学意义(χ2=4.7619,P<0.05),术后1mo两组患者眼压均能控制在21mmH g以下。结论:对于复杂视网膜脱离,采取玻璃体切除联合下方巩膜外垫压治疗安全、操作准确,相对于单纯玻璃体切除手术更有助于术后视网膜的解剖复位和黄斑水肿的早期消退。

AIM： To evaluate the efficiency of two different operation ways, vitrectom y and vitrectom y com bined with inferior scleral buckling,for a com plex kind of retinal detachm ent.METHODS： The complex kind of retinal detachment were diagnosed in 100 cases（ 100 eyes）, with the com m on features： 1） the course of m ore than 1m o; 2） at least one retinal hole located in the inferior m arginal retina; 3） the detachm ent of retina was found proliferated,there was at least 1 retinal fold in retinal detachm ent area.The patients were random ly divided into two groups： the treatm ent group（ 50 eyes） who received vitrectom y com bined with inferior scleral buckling; the control group（ 50 eyes） who received vitrectomy without scleral buckling. The retinal anatom ic reattachm ent, visual function recovery, m acular central fovea thickness and com plications in two groups were observed.RESULTS： There were 49 eyes（ 98%） with retinal anatom ic reattachm ent in the treatm ent group while 42eyes（ 84%） in control group（ χ2= 4. 2605,P〈0. 05）; the best corrected visual acuity（ BCVA） was 0. 254 ± 0. 238 in the treatm ent group while it was 0. 219±0. 229 in control group（ t = 1. 8879,P〉0. 05）; the macular central fovea thickness was 272 ± 32. 21μ m in the treat group while it was 316 ±33. 46μ m（ t = 12. 597,P〈0. 01）. Intraocular pressure in 12eyes（ 24%） was m ore than 30 m m Hg in the treatm ent group while 4 eyes（ 8%） in control group within 1wk postoperation（ χ2= 4. 7619,P〈0. 05）; intraocular pressure in 100 eyes were controlled below21 m m Hg 1m o postoperatively.CONCLUSION： It is a more effective method tovitrectom y com bined with inferior scleral buckling than the single vitrectom y for the special kind of retinal detachm ent. It can increase the rate of retinal anatom ic reattachm ent and reduce m acular edema.