25G玻璃体切除术联合空气填充治疗原发性孔源性视网膜脱离的短期疗效

Short-term effects of 25G vitrectomy with air tamponade for primary rhegmatogenous retinal detachment

目的观察25G玻璃体切除术联合眼内无菌空气填充治疗原发性孔源性视网膜脱离的疗效。设计回顾性病例系列。研究对象2016年8-12月北京同仁医院接受25G经睫状体平坦部三通道微创玻璃体切除术联合无菌空气填充治疗的原发性孔源性视网膜脱离患者13例(13眼)。上方单一裂孔8例,多发裂孔4例,黄斑裂孔1例。方法术前均行矫正视力、眼压、裂隙灯检查、间接检眼镜、彩色眼底照相、眼部彩色多普勒超声和相干光断层扫描检查。术后平均随访(67±26)天。主要指标矫正视力、眼压、视网膜复位及手术并发症情况。结果末次随访时13眼(100%)视网膜脱离全部复位。3例在术后第3天发生脉络膜脱离,口服糖皮质激素治疗后好转。术后平均logMAR矫正视力(0.63±0.43),与术前比较差异有统计学意义(配对秩和检验S=-34,P=0.005)。末次随访平均眼压(15.95±4.12)mmHg,与术前比较差异有统计学意义(t=-2.65,P=0.02)。结论空气短期填充可作为25G玻璃体切除术治疗脱离位于上方、未超过3个象限的原发性孔源性视网膜脱离的一种选择方法。

Objective To evaluate the effects of 25G vitrectomy with sterile air tamponade in primary rhegmatogenous retinal de- tachment （RRD） surgery. Design Retrospective case series. Participants RRD cases who underwent 25G minimally invasive vitreetomy with three channels through the pars plana of ciliary body with sterile air tamponade were consecutively collected from Aug. to Dec. 2016. Methods Best corrected visual acuity （BCVA）, intraocular pressure （IOP）, slit lamp microscope, indirect ophthalmoscope, color fundus photography, color doppler ultrasound and optical coherence tomography （OCT） were performed before surgery. Patients were fol- lowed up after operation, and the BCVA, IOP, retinal reattachment and complications were observed. Main Outcome Measures BCVA, IOP, retinal reattachment and complications. Results At the last follow-up visit, the retina reattached in all 13 eyes （100%）. Choroidal detachment occurred in 3 cases on postoperative day 3, which improved after oral prednisone. Postoperative BCVA was logMAR 0.63± 0.43, which improved significantly compared to preoperative value （Compared rank sum test, S=-34, P=0.005）. At the last follow up visit, the average IOP was 15.95±4.12 mmHg, significantly different from pre-operative value （t=-2.65, P=0.02）. Conclusion Short-term air tomponade combined with 25G vitrectomy can be used as an alternative choice for primary rhegmatogenous retinal detachment with tear located above and not exceeding 3 quadrants. （Ophthalmol CHN, 2018, 27： 377-380）