视网膜裂孔的早期诊断与治疗

Early diagnosis and treatment of the retinal breaks

目的探查视网膜裂孔最实用的检查方法，评价视网膜裂孔早期诊断与治疗的价值。方法192例（216眼）经眼科A／B超检查确诊为玻璃体后脱离（PVD）的患者，散瞳后分别行间接检眼镜、在裂隙灯下90D前置镜以及三面镜行眼底检查。对周边视网膜存在裂孔不伴有周围视网膜脱离或伴有局部浅脱离的患者，早期用532nm激光环绕裂孔进行光凝治疗；裂孔周围伴有视网膜脱离的患者行手术治疗。结果216眼PVD患者中间接检眼镜发现视网膜裂孔28眼，占12．96％；在裂隙灯下90D前置镜发现视网膜裂孔26眼，占12．04％；三面镜发现视网膜裂孔31眼，占14．35％，三者比较差异未见统计学意义（P〉0．05）。22眼视网膜裂孔周围无视网膜脱离，行预防性光凝治疗1次；6眼视网膜裂孔周围伴小范围视网膜浅脱离，行光凝治疗2次；3眼视网膜裂孔周围伴视网膜脱离范围稍大，行巩膜外冷凝＋巩膜外垫压术复位视网膜。随访6个月，所有视网膜裂孔治疗效果良好，未发现新的视网膜脱离发生。结论视网膜裂孔的早期发现、早期诊断非常重要，及时适当的激光光凝治疗是预防视网膜脱离发生的关键，三面镜仍然是查找视网裂孔非常实用的检查工具，应得到基层眼科医生的重视和应用。

Objective To investigate the most practical examination method for diagnosis and treatment of retinal breaks and evaluate the value of early diagnosis and treatment for retinal breaks. Methods A total of 192 patients （216 eyes） diagnosed as posterior vitreous detachment （PVD） by ophthalmic A/B ultrasound underwent indirect ophthalmoscope, 90D mirror under the slit lamp, and threemirror lens fundus examinations after mydriasis. Patients with retinal breaks uncombined with peripheral retinal detachment or accompanied by local superficial detachment were treated by 532 nm laser photoco- agulation around the breaks; while patients with retinal breaks accompanied by peripheral retinal detachment were treated by surgery. Results In 216 eyes of PVD patients, 28 eyes of retinal tears were found by indirect ophthalmoscope, accounting for 12. 96% ; 26 eyes of retinal tears were found by the 90D under the slit lamp, accounting for 12.04% ; 31 eyes of retinal tears were found by three-mirror lens, accounting for 14.35%, and there was no significant difference among the three groups inexamination results （ P 〉 0. 0 5 ） . Twenty - two eyes with retinal tears uncombined with peripheral retinal detachment underwent preventive photocoagulation treatmen for once; 6 eyes with retinal tears accompanied by local superficial detachment underwent retinal photocoagulation for 2 times; 3 eyes with retinal breaks accom- panied by large range retinal detachment underwent scleral cryotherapy combined with scleral buckling. Followed up for 6 months, all the patients with retinal breaks had good therapeutic effect, without new retinal detachment. Conclusions Early detection and early diagnosis for retinal breaks are very important. The timely and proper treatment of retinal photocoagulation is the key to prevent the occurrence of retinal detachment; three-mirror lens is still very useful to detect retinal breaks. Primary level doctors should pay attention to the the importance and application of these methods.