巩膜外加压治疗硅油眼复发性视网膜脱离

Sclera Buckling for Recurrent Retinal Detachment in Silicone Oil Tamponaded Eyes

目的：评价巩膜外加压术治疗硅油填充眼复发视网膜脱离的效果。方法：回顾性分析我院2013年1月至2016年4月间收治的硅油填充术后发生视网膜脱离并行巩膜外加压治疗的患者54例54只眼。观察其术后至眼内硅油取出3月内视网膜复位、视力及眼压情况。结果：巩膜外加压术后视网膜复位48例,6例术后随访中发现视网膜未复位而改行玻璃体切割联合硅油填充术,再次手术后视网膜复位。术后术眼眼压增高超过25mmHg者18例,其中,4例取出部分硅油后眼压降至正常,其余14例保守治疗1周内眼压恢复正常。结论：对于硅油眼复发性视网膜脱离,如裂孔位于下方或较周边处,增生性玻璃体视网膜病变处于A或B级,屈光介质不影响眼底检查,可首选巩膜外加压术治疗。

Objective： To explore the effect of sclera buckling on recurrent retinal detachment in silicone oil tamponaded eyes. Methods： Fifty-four cases （54 eyes） of recurrent retinal detachment after vitretomy and silicone oil tamponaded for different reasons from Jan. 2013 to Apr. 2016 were retrospectively studied. Among them, 38 cases showed recurrent inferotemporal retinal detachment, 18 cases were combined with the removal of part silicone oil, 7 cases with aqueous humor and 3 cases were injected with sterile air to maintain normal intraocular pressure. All the cases received sclera buckling and were observed with the change of retinal reattachment, visual acuity and in- traocular pressure （IOP） until three months after silicone oil removal. Results.. Among 48 cases of postoperative retinal reattachment, 6 cases were performed by diverted vitrectomy combined with silicone oil tamponade followed by second retinal reattachment due to retinal detachment again within followed-up period. Postoperative intraocular pressure was higher than 25 mmHg in 18 cases, of which 4 cases received the second surgery to remove part of silicone oil, and the re- maining 14 cases of conservative treatment to restore normal intraocular pressure within one week. Conclusion： As for limited retinal detachment caused by inferior or peripheral holes with A or B-class of proliferative vitreoretinopathy, if the refractive medium does not affect the fundusexamination, sclera buckling is firstly recommended for recurrent retinal detachment in silicone oil tamponaded eyes.