11例巩膜扣带术后复发性视网膜脱离原因分析和处理

Cause and management of recurrent retinal detachment after scleral buckling in 11 cases

目的巩膜扣带术后复发性视网膜脱离是严重危害患者视力的复杂性视网膜脱离,其原因很多,本研究回顾性分析11例巩膜扣带术后复发性视网膜脱离的患者,研究复发性视网膜脱离的原因和处理方法,为此类患者的治疗提供临床依据。方法收集2016年1月—2017年12月中国科学技术大学附属第一医院收治的11例(11只眼)巩膜扣带术后复发性视网膜脱离患者的临床资料,通过收集眼底检查、再次手术方式和视力情况,分析复发原因和手术方式选择及视功能恢复情况。结果复发性视网膜脱离患者中原裂孔哆开的为3只眼,新发裂孔的为8只眼,合并人工晶体眼2例2只眼,高度近视3例3只眼,PVR B级的为1眼,C1级的为8眼,C2级的2眼,具有陈旧性视网膜脱离特征的共5例5只眼。再次施行巩膜扣带术1只眼;玻璃体切除(简称“玻切”)+C3F8填充1只眼;玻切+硅油填充的9只眼。术后视网膜均已复位。术后患者平均最佳矫正视力为3.61±1.20,与术前平均最佳矫正视力(3.26±1.14)比较明显提高,差异有统计学意义(t=-3.121,P<0.05,95%CI:-0.592^-0.098)。结论原裂孔哆开、视网膜增殖导致新发裂孔、术中冷冻过强等原因是巩膜扣带术后复发视网膜脱离的主要原因。对于年轻人,无PVR,局限性视网膜脱离尽量再次选择巩膜扣带术;玻切术中尽量以激光封闭裂孔为主,可预防性眼内嵴后或360°赤道部3~4排激光;PVR C2级以上患者,尽量选择硅油填充。

Objective To retrospectively analyze 11 patients with recurrent retinal detachment after scleral buckling,in-vestigate the causes and treatment of recurrent retinal detachment,and provide clinical basis for the treatment.Methods Total 11 patients(11 eyes)with recurrent retinal detachment after scleral buckling surgery in our hospital from January 2016 to December 2017 were collected.The causes of recurrence,the choice of surgical methods and the recovery of visual function were analyzed by fundus examination,reoperation and visual acuity.Results Fundus exami-nation showed that in patients with recurrent retinal detachment,there were 3 eyes with primary tears,8 eyes with new tears,2 eyes with intraocular lens and 3 eyes with high myopia.PVR analysis showed that 1 eye was grade B,8 eyes were grade C1,2 eyes were grade C2.There were 5 cases(5 eyes)with old retinal detachment signs.Re-operation:scleral buckling was performed again in 1 eye,vitrectomy+C3F8 filling in 1 eye,and vitrectomy+silicone oil filling in 9 eyes.The retina had been restored after operation in all patients.The average best corrected visual acuity of postop-erative patients was 3.61±1.20,significantly higher than that of preoperative patients(3.26±1.14),with statistical significance(t=-3.121,P<0.05,95%CI:-0.592 to-0.098).Conclusion The main causes of retinal detach-ment after scleral buckling surgery are the opening of the primary hole,retinal hole re-opening the new hole by the prolif-eration of the retina,and strong freezing during operation.High myopia and intraocular lens may be the risk factors.For young people without PVR,the scleral buckling surgery should be first choice to treat rhegmatogenous retinal detachment.In vitrectomy,the membrane should be stripped as clean as possible,and the laser should be used as the main method,and 360 degrees of laser therapy should consider.For patients with PVR grade C2 or above,silicone oil should be used firstly.