硅油眼复发性视网膜脱离的临床特征及手术术式选择的分析

Analysis of the Clinical Characteristics and the Choice of Surgical Methods of Recurrent Retinal Detachment in Silicone Oil Eyes

目的:探讨硅油眼复发性视网膜脱离的原因,分析其临床特征及手术术式的选择。方法:收集2017年1月—2021年10月新疆军区总医院全军眼科中心玻璃体切割术后硅油眼复发性视网膜脱离的患者46例(46只眼),进行回顾性分析。描述分析其原发疾病、复发性视网膜脱离的原因,以及再次手术的术式和预后情况。结果:46例硅油眼复发性视网膜脱离的患者中,高度近视性视网膜病变和增殖性玻璃体视网膜病变的患者明显多于其他患者。引起复发性视网膜脱离的病因主要为视网膜裂孔和增殖膜的形成,并且视网膜脱离位于下方的患者明显较多。再次手术术式包括巩膜扣带术及二期硅油取出术、硅油置换术、硅油取出联合巩膜扣带术,最终42例患者硅油取出后视网膜复位良好,有4例行新硅油充填术的患者硅油未取出。结论:高度近视及增殖性玻璃体视网膜病变患者的硅油眼复发性视网膜脱离发生率较高,其主要原因是裂孔和增殖膜的形成。依据临床特征合理选择手术方式不仅可以提高视网膜复位率,还可以减少患者手术次数及经济负担。

Objective:To investigate the causes of recurrent retinal detachment in silicone oil eyes,and analyze its clinical characteristics and the choice of surgical methods.Methods:Medical records of 46 patients(46 eyes)inpatients with recurrent retinal detachment in silicon oil tamponaded eyes from January 2017 to October 2021 in Eye Center of the Xinjiang Military Region General Hospital were collected and set rospectively analyzed.To describe and analyze the primary disease,the causes of recurrent retinal detachment,and the surgical methods and prognosis of reoperation.Results:Among the 46 patients with recurrent retinal detachment in silicone oil eyes,the patients with high myopia retinopathy and proliferative vitreoretinopathy were significantly more than the other patients.The main causes of recurrent retinal detachment are retinal breaks and the formation of proliferative membranes,and there are obviously more patients with retinal detachment below.The reoperation methods include scleral buckling and secondary silicone oil removal,silicone oil replacement,silicone oil removal and scleral buckling.Finally,42 patients had good retinal reattachment after silicone oil removal,4 patients with new silicone oil filling did not have silicone oil removed.Conclusion:The incidence of recurrent retinal detachment in silicone oil eyes is high in patients with high myopia and proliferative vitreoretinopathy.The main reasons are the formation of holes and proliferative membranes.The reasonable selection of surgical methods according to clinical characteristics can not only improve the rate of retinal reattachment,but also reduce the number of operations and economic burden of patients.