不同术式治疗黄斑裂孔视网膜脱离的临床观察

Effect of different surgical methods for retinal detachment with macular hole

目的 评价不同手术方式治疗黄斑裂孔视网膜脱离 (retinal detachment,RD)的疗效。方法 回顾性分析 1997年 6月～ 2 0 0 0年 3月经不同术式治疗的黄斑裂孔性 RD连续病例 192例患者 196只眼 ,其中采用单纯注气术 10 2只眼 ,注气术联合巩膜扣带术 (scleral bucking surgery,SBS) 5 2只眼 ,玻璃体视网膜手术 (vitreoretinalsurgery,VRS)联合 SBS18只眼。随访 2～ 6 1个月 ,平均 7.6± 10 .5个月。结果 复位 16 4只眼 (83.6 7% ) ,好转 16只眼 (8.16 % ) ,16只眼 (8.16 % )失败 ,总有效率 91.84 % ,其中单纯注气术组有效率 93.13% ,注气联合 SBS组94 .2 3% ,VRS组 83.33% ,VRS联合 SBS组 88.89%。最终治愈的 180只眼中视力提高者 92只眼 (5 1.11% ) ,其中单纯注气术组 4 4 .12 % ,注气联合 SBS组 5 3.85 % ,VRS组 5 0 .0 0 % ,VRS联合 SBS组 5 0 .0 0 %。有严重增生性玻璃体视网膜病变 (proliferative vitreoretinopathy,PVR)、黄斑“白孔”、玻璃体牵引及术前有 RD复位手术失败史则显著影响手术效果。结论 按其适应证选择不同术式治疗的黄斑裂孔 RD,均能达到较好的解剖及功能复位。手术成功的关键是术前根据玻璃体视网膜情况 。

Objective To evaluate the effect of four different surgical methods for retinal detachment(RD) with macular hole.Methods 192 consecutive cases(196 eyes) of RD with macular hole in our institute form June 1997 to March 2001 were analysed retrospectively.Among them,102 eyes were treated with pneumatic retinopexy and 52 eyes with pneumatic retinopexy combined with scleral bucking surgery(SBS) and 24 eyes with vitreoretinal surgery(VRS) combined with gas (SF 6 or C 2F 6) or silicon oil tamponade or combined with SBS.Follow-up period ranged from 2 to 61 months,and with an average period of 7.6 months.Results The operation was effective in 180 eyes(91.84%) and failure in 16 eyes(8.16%),and the visual acuity was increased 92 eyes(51.11%) and 0.1 or more in 26 eyes(14.44%),while in term of visual recovery,and no change in 62 eyes(34.44%),and decreased 26 eyes(14.44%).The effect factors of operation are proliferative vitreoretinopathy,'white hole in macular',Vitreous traction in perifoveal and undergone unsuccessful conventional RD surgery.Conclusion Each method has its own indication.Properative careful examination of vitreous and ocular fundus and rational surgical design.