手术显微镜直视下巩膜外加压治疗孔源性视网膜脱离的临床观察

Clinical observation of scleral buckling in the treatment of rhegmatogenous retinal detachment under surgical microscope

目的观察显微镜直视下巩膜外加压治疗孔源性视网膜脱离(RRD)的临床疗效。方法纳入2016年9月至2017年9月于中国中医科学院眼科医院玻璃体视网膜病科诊断为RRD,并首次接受巩膜外加压术的患者18例(20只眼)的临床资料,在显微镜下进行巩膜外加压手术,所有患者随访1~12个月,平均(6.1±1.2)个月,观察视力、视网膜复位率及并发症等。术前与术后患者的视力按照<0.05,0.05~0.30和>0.30分为三类,采用眼数和百分比进行描述,比较采用KruskalWallis H秩和检验。结果在本研究所观察的病例中,视网膜全部复位,无重大并发症发生。其中,有6例(6只眼)患者需联合玻璃体腔注气术治疗,术后1~2周完全吸收。所有病例均予以巩膜穿刺放液,残余视网膜下液多在术后2周左右完全消退,但有2例(2只眼)患者在术后半年才完全吸收。此外,有4例(4只眼)患者术后补充视网膜裂孔周围激光光凝。随访过程中观察到病例中原病变区视网膜裂孔全部闭合,视网膜复位率100%。12例(13只眼)术后视力得以提高,6例(7只眼)术后视力无变化。因巩膜外加压导致眼球形态由原来的近似正球形发生改变。部分病例屈光度发生改变,视网膜脱离累及黄斑区者在视网膜下液吸收、黄斑复位后,视力有部分提高,经Kruskal-Wallis H秩和检验,差异有统计学意义(Hc=8.62,P<0.05)。有4例(4只眼)出现术后轻度双眼复视,5~7 d后症状消失,眼球运动无受限;13例(13只眼)术后因结膜缝线刺激主诉异物感,拆除缝线后无不适;1例(1只眼)术后结膜切口延期愈合。结论显微镜下外路视网膜脱离复位手术可以提高视网膜裂孔的封闭率,提高手术成功率,避免一部分手术并发症。

Objective To observe the clinical efficiency of scleral bucking surgery under the microscope for the treatment of rhegmatogenous retinal detachment（RRD）. Methods The clinical data of 18 patients （20 eyes）, diagnosed as RRD in the vitreoretinopathy Department of the ophthalmological Hospital of Chinese Academy of traditional Chinese medicine, from September 2016 to September 2017, were treated with scleral pressure surgery under microscope. All patients were followed up for 1~12 months, with an average of （6.1±1.2） months, observation and observation. Force, retinal reposition rate and complications. The visual acuity of the patients before and after operation was divided into three categories according to 〈0.05, 0.05～0.30 and 〉0.30. The number and percentage of eyes were described with Kruskal-Wallis H rank sum test. Results In the cases observed in this study, the retina of the patient was completely restored without significant complications. 6 patients（6 eyes） were treated with vitreous cavity gas injection, and vitreous cavity gas was absorbed completely after 1~2 weeks. All cases were given scleral puncture drainage, and residual subretinal fluid completely subsided around 2 weeks after operation. However, 2 patients（2 eyes） were completely absorbed after six months. In addition, 4 patients（4 eyes） received laser photocoagulation around the retinal hole after operation. During the follow-up, all the retinal holes in the central lesion area were closed and the retinal reattachment rate was 100%.Visual acuity was improved in 12 patients（13 eyes） and no change in visual acuity was found in 6 patients（7 eyes）. Due to scleral buckling, the shape of the eyeball changes from the original approximately spherical shape. In some cases, the diopter was changed. The visual acuity was partly improved after retinal detachment and macular reduction. The difference was statistically significant （Hc=8.62, P〈0.05） after Kruskal-Wallis H. There were 4 cases（4 eyes） of postoperative mild binocular diplopia, 5~7 days after the symptoms disappeared, the eyeball movement was not limited; 13 cases（13 eyes） of conjunctival suture stimulation after the main complaint of foreign body sensation, after the dismantling suture is not unsuitable, 1 case（1 eye） of conjunctival incisional nonunion. Conclusion It′s practicable to replace traditional external surgery by external retinal detachment surgery under the microscope. With the advantages of high magnification microscope, retinal hiatus closure rate and surgical success rate can be improved, and avoiding some surgical complications.