最小量手术治疗单纯孔源性视网膜脱离的临床研究

Clinical research of minimal surgery for simple rhegmatogenous retinal detachment

目的探讨治疗单纯孔源性视网膜脱离的最优手术方案。方法将2015年9月至2018年1月我院收治的新发、单个或裂孔位于1个钟点位内的上方孔源性视网膜脱离患者82例(82眼)按照手术方式的不同分为3组:采用巩膜外扣带术的患者为A组,采用玻璃体腔消毒空气填充后裂孔周围激光封闭的患者为B组,采用巩膜外冷凝及玻璃体腔消毒空气填充封闭裂孔的患者为C组。观察3组患者手术前后最佳矫正视力、屈光度、眼压、视网膜脱离复位率、前节炎症反应等指标,并定期随访。结果与术前相比,3组患者术后视力、屈光度有不同程度改善,差异有统计学意义(P <0. 05),眼压差异不明显。3组患者术后视力、屈光度、眼压比较,差异无统计学意义(P> 0. 05)。术后A组和C组患者眼前节炎症反应较重,3组间差异有统计学意义(P=0. 000);术后2周之内,3组患者复位率均为90%以上;随访2周、1个月、3个月、6个月、12个月,B组有2例患者术后1个月再次发生视网膜脱离或视网膜脱离未复位,另行巩膜外扣带术后视网膜完全复位,其余患者均无视网膜脱离复发及严重并发症发生。结论激光或冷凝封闭裂孔联合玻璃体腔消毒空气填充术是新发、上方孔源性视网膜脱离治疗有效的最小量手术方式,但需要把握适应证。

Objective To investigate the minimally surgical procedure for simple rhegmatogenous retinal detachment( RRD). Methods A total of 82 RRD patients( 82 eyes) with new-onset,single hole or split holes,located within small area,from September 2015 to January2018 in our hospital were randomly divided into three groups: the patients in group A were treated with scleral buckling;the patients in group B were treated with sterile air intravitreal injection after laser photocoagulation;the patients in group C were treated with sterile air intravitreal injection with scleral cryotherapy. Best correct visual acuity( BCVA),diopter,intraocular pressure( IOP),retinal re-attachment ratio,preoperative anterior segment inflammation and postoperative anterior segment inflammation were observed. Results Compared with preoperative,the BCVA and Diopter were improved in different degree of 3 groups,the differences were significant( P < 0. 05),the IOP had no obvious difference. The postoperative BCVA,Diopter and IOP of the 3 groups were compared,the differences were not signifcant( P > 0. 05). The anterior segment inflammation of group A and group C were serious,there were statistically significant differences between the 3 groups( P = 0. 000).The retinal re-attachment ratio in 3 groups were all over 90% within 2 weeks. All patients were followed up at 2 weeks,1 months,3 months,6 months and 1 years,expect 2 patients in group B with recurrent retinal detachment or retinal detachment was not reset received scleral buckling surgery and succeeded in 1 month after operation,no recurrence of retinal detachment nor serious complications occurred in the other patients. Conclusion Retinal photocoagulation or cryotherapy,combined with intravitreal injection of sterile air is a minimal invasive treatment for the fresh retinal detachment and superior RRD,however,the indications should be identified.