视网膜脱离行玻璃体切除联合惰性气体填充术后视力下降原因分析

Analysis on visual acuity decline after vitrectomy with inert gas tamponade in rhegmatogenous retinal detachment

目的探讨孔源性视网膜脱离,行玻璃体切除联合惰性气体填充术后,患者视力下降的原因。方法回顾性病例序列研究。收集2008~2010年在我院因孔源性视网膜脱离行玻璃体切除联合惰性气体填充术后的患者156例的临床资料,观察其中视力下降者手术后视网膜复位情况、手术前后最佳矫正视力、手术前后视神经、黄斑区改变,并分析视力下降的原因。结果 156例中视力明显下降者5例,其中男2例,女3例,年龄27~59岁,平均(47.6±12.5)岁。5例患者均因孔源性视网膜脱离行玻璃体切除+重水+视网膜复位+眼内光凝+惰性气体填充术,术中2例使用C_2F_6气体,3例使用C_3F_8气体,术前最佳矫正视力为0.1~1.0。5例患者手术后视网膜均成功复位。惰性气体基本吸收后,5例患者均发生视力下降,术后随访1个月~6年,患者术后最佳矫正视力0.03~0.2,其中3例发生视神经萎缩。OCT显示2例黄斑区中心凹曲线变平,2例黄斑区薄变,1例发生黄斑裂孔,5例患者术后全部采用严格俯卧位。结论玻璃体切除联合惰性气体填充术后患者视力下降的原因较为复杂,除视网膜脱离是否累及黄斑、使用惰性气体的浓度、术后眼压、术后白内障等因素外,还可能与患者术后严格俯卧位,导致视网膜呈脱水状态有关。

OBJECTIVE To investigate the cause of visual acuity decreased in patients with rhegmatogenous retinal detachment after vitrectomy combined with inert gas filling. METHODS It was a retrospective case study.From 2008 to 2010, 156 cases underwent vitrectomy combined with inert gas filling due to rhegmatogenous retinal detachment in our hospital were studied, to observe their retinal condition after surgery, the best corrected visual acuity（BCVA）, variation of optic nerve and macula before and after surgery. Then the reason for the vision decline was analyzed. RESULTS There were 5 cases＇ visual acuity dropped in 156 cases, including 2 males and 3 females,aged 27 to 59 years and the mean age was 47.6 ± 12.5 years.The five patients were treated by vitrectomy, heavy water,retinal reattachment, intraocular photocoagulation and inert gas filling. Specifically, two patients were dealt with C2F6 gas and 3 cases were treated by C3F8 gas. Their preoperative BCVA ranged from 0.1 to 1.0 and five patients all enjoyed successful retinal reattachment. After absorption of inert gas, 5 patients suffered visual acuity decline. The patients were followed up for 1 month to 6 years, the BCVA ranged from 0.03 to 0.2, and 3 of them developed optic atrophy. The optical coherence tomography showed flattened curve of central fovea of macula in two cases, macular degeneration in 2 cases, macular hole in 1 case. The five patients all followed prone position strictly after surgery.CONCLUSIONS The reason for the decreased visual acuity of patients after vitrectomy combined with inert gas filling were complex. In addition to retinal detachment involving macular damage, the gas concentration, postopera-tive intraocular pressure, postoperative cataract and other factors, it might also concern retinal dehydration status due to the strictly prone position after surgery.