微创玻璃体切割手术治疗儿童及青少年特殊类型孔源性视网膜脱离的疗效观察

Clinical efficacy of minimally invasive vitreous surgery for special rhegmatogenous retinal detachment in children and adolescents

目的观察微创玻璃体切割手术治疗儿童及青少年特殊类型孔源性视网膜脱离(RRD)的临床效果。方法回顾性研究。2014年1月至2019年1月在空军军医大学西京医院眼科行微创玻璃体切割手术治疗的儿童及青少年特殊类型RRD患者14例14只眼纳入研究。其中,男性8例8只眼,女性6例6只眼。年龄5~17岁,平均年龄(12.64±4.11)岁。病程1d^1年,平均病程30 d。所有患眼均为特殊类型RRD,包括人工晶状体眼及无晶状体眼视网膜脱离、巨大裂孔性视网膜脱离、脉络膜脱离型视网膜脱离、伴有眼部发育异常的RRD等。14只眼中,视网膜脱离累及1个象限2只眼,2个象限4只眼,3个象限1只眼,4个象限7只眼。所有患眼均接受23G或25G微创玻璃体切割手术治疗,并填充灌注液、空气或硅油。手术后平均随访时间10.4个月。观察患眼视网膜复位、BCVA以及相关并发症的发生情况。结果14只眼中,一次手术后视网膜复位13只眼(92.9%),视网膜复位不良1只眼(7.1%)。末次随访时,视网膜复位14只眼(100.0%);其中5只眼为硅油填充状态。视力提高8只眼(57.1%),无明显变化4只眼(28.6%),下降2只眼(14.3%)。手术中1只眼出现医源性视网膜裂孔,1只眼硅油进入视网膜下。手术后1只眼硅油取出后视网膜脱离复发再次硅油填充。结论微创玻璃体切割手术治疗儿童及青少年特殊类型RRD安全有效,一次手术后视网膜复位率92.9%,末次随访时视网膜复位率100.0%;其可促使大部分患眼视力稳定或提高。

Objective To observe the clinical efficacy of minimally invasive vitreous surgery(MIVS)for special rhegmatogenous retinal detachment(RRD)in children and adolescents.Methods A retrospective clinical comparative study.Fourteen eyes with special type of RRD in 14 children and adolescents who received the MIVS treatment from January 2014 to January 2019 in Ophthalmology Department of The First Affiliated Hospital Ophthalmology of Air Force Military Medical University,were included in this study.Among them,8 eyes from 8 males and 6 eyes from 6 females.The age of them ranged from 5 to 17,with the mean age of 12.64±4.11 years.The course of disease was ranged from 1 d to 1 year,and the average of it was 30 d.All the eyes developed the special type RRD,including pseudophakic and aphakic retinal detachment,giant retinal tear with retinal detachment,choroidal detachment associated with retinal detachment,and RRD with ocular dysplasia.In the 14 eyes,there was 2 eyes with retinal detachment in 1 quadrant,4 eyes in 2 quadrants,1 eye in 3 quadrants and 7 eyes in total 4 quadrants.All the eyes were treated with 23G or 25G MIVS and filled with irrigation solution,air and silicone oil.In addition,10.4 months'follow-up for average after surgery were taken to observe the occurrence of retinal reattachment,BCVA and related complications in the eyes.Results In the 14 eyes,13(92.9%)of them attained retinal reattachment and 1 eye(7.1%)got a poor retinal reattachment after one operation.At the last follow-up,all the 14 eyes(100.0%)attained retinal reattachment and 5 of them at the filling state of silicone oil.The vision of 8 eyes(57.1%)were improved,4 eyes(28.6%)have no notable changes and 2 eyes decreased(14.3%).During the operation,iatrogenic retinal breaks were occurred in 1 eye,and silicone oil entered underneath the retina in 1 eye.After the operation,1 eye suffered a relapse of retinal detachment after the removal of silicone oil and then were filled with it again.Conclusions MIVS is a safe and effective way to treat the special type RRD among the children and adolescents.The rate of retinal reattachment is 92.9%after one surgery and 100.0%at the last follow-up.Therefore,MIVS can help most of eyes with special type RRD to get a stable and improved vision.