玻璃体切割联合巩膜外垫治疗复杂视网膜脱离临床研究

Efficacy of vitrectomy combined with scleral buckling in treatment of complex retinal detachment

目的探讨玻璃体切割联合下方巩膜外垫治疗复杂视网膜脱离的疗效及安全性。方法将79例复杂视网膜脱离患者随机分为观察组41例与对照组38例,两组均行玻璃体切割术,观察组联合使用下方巩膜外垫治疗。对两组治疗后视网膜解剖复位情况、最佳矫正视力(BCVA)、眼压以及术后并发症进行评价。结果在术后1个月及3个月时,观察组视网膜解剖复位率(90.24%、97.56%)均显著高于对照组(71.05%、84.21%)(P<0.05)。术后两组BCVA均得到了显著提升,观察组术后3 d及1 w时BCVA及眼压均高于对照组(P<0.05),但术后3个月时两组差异不显著(P>0.05)。观察组角膜水肿发生率(2.44%)低于对照组(15.79%)(P<0.05),但观察组并发症总发生率(19.51%)与对照组(34.21%)比较,差异无统计学意义(P>0.05)。结论与单纯玻璃体切割相比,玻璃体切割联合下方巩膜外垫治疗复杂视网膜脱离,视网膜解剖复位更好,利于患者术后早期恢复,且并发症发生率较低,值得临床推广。

Objective To explore the efficacy and safety of vitrectomy combined with scleral buckling in the treatment of complex retinal detachment. Methods A total of 79 patients with complex retinal detachment were selected and randomly divided into an observation group(n=41) and a control group(n=38). The two groups were treated with vitrectomy, and the observation group was additionally treated with scleral buckli ng. The post-treatment anatomical reattachment of retina, BCVA, intraocular pressure and postoperative complications in the two groups were evaluated. Results One and three months after the operation, the retinal reattachment rate in the observation group(90.24% and 97.56%) was significantly higher than that in the control group(71.05% and84.21%)(P < 0.05). After the operation, the BCVA in the two groups increased greatly; the BCVA and intraocular pressure three days and one week after the operation in the observation group were higher than those in the control group(P < 0.05); however, three months after the operation, there was no significant difference between the two groups(P > 0.05). The incidence of corneal bedewing(2.44%) in the observation group was lower than that in the control group(15.79%)(P < 0.05); however, there was no statistical difference in the overall incidence between the observation group(19.51%) and the control group(34.21%)(P > 0.05). Conclusion The treatment of complex retinal detachment with vitrectomy combined with scleral buckling can ensure better anatomical reattachment of retina, earlier postoperative recovery and lower incidence of complications than that with vitrectomy only, and is worthy of clinical popularization.