巩膜扣带术治疗儿童青少年特殊类型孔源性视网膜脱离的临床观察

Observation on clinical efficacy of scleral buckling for the treatment of special rhegmatogenous retinal detachment in children and adolescents

目的观察巩膜扣带术治疗儿童青少年特殊类型孔源性视网膜脱离(RRD)的临床特征及效果。方法回顾性队列研究。空军军医大学西京医院眼科2014年1月至2020年1月行巩膜扣带术治疗的儿童青少年特殊类型RRD 45例(50眼)纳入研究。本组特殊类型RRD包括以视网膜下增生膜为主的陈旧性视网膜脱离29眼、伴有脉络膜脱离视网膜脱离4眼、伴有家族性渗出性玻璃体视网膜病变(FEVR)的视网膜脱离14眼等。手术后随访6个月~2年,观察手术后视网膜复位、最佳矫正视力(BCVA)及相关并发症的发生情况。结果本研究50眼中,一次手术后视网膜复位者39眼(78.00%,39/50):其中3眼术后1个月后视网膜脱离复发,给予2眼玻璃体切除术硅油填充后复位,1眼再次行巩膜垫压带调整后复位;视网膜复位不良者11眼(22.00%,11/50):其中9眼为局部视网膜下增生膜支撑,长期观察视网膜下增生膜稳定无处理,2眼玻璃体切除术并硅油填充后复位。末次随访时,仅经一次巩膜扣带术视网膜完全复位36眼(72.00%,36/50);最终视网膜复位41眼(82.00%,41/50),其中2眼为硅油填充状态;好转9眼(18.00%,9/50)。视力提高29眼(58.00%,29/50),无明显变化19眼(38.00%,19/50),下降2眼(4.00%,2/50)。结论巩膜扣带术治疗儿童青少年特殊类型RRD安全有效,可使大部分患眼视网膜复位、视力提高或稳定。

Objective To observe the clinical characteristics and efficacy of scleral buckling(SB)on the treatment of special rhegmatogenous retinal detachment(RRD)in children and adolescents.Methods This was a retrospective cohort study.A total of 50 eyes of 45 children and adolescents with special type of RRD who received SB from Jan.2014 to Jan.2020 in,the First Affiliated Xijing Hospital of Air Force Medical University were included in this study.The special types of RRD in this study included 29 eyes of long-standing retinal detachment with predominantly subretinal proliferative membrane,4 eyes of retinal detachment with choroidal detachment,and 14 eyes of retinal detachment with familial exudative vitreoretinopathy(FEVR),etc.After surgery,the patients were followed up for 6 months to 2 years to observe the occurrence of retinal repositioning,best corrected visual acuity(BCVA)and related complications.Results Among the 50 eyes in this study,39 eyes(78.00%,39/50)attained retinal reattachment after primary surgery:3 eyes of them suffered retinal detachment recurrence 1 month after surgery,among which 2 eyes attained reattachment after vitrectomy with silicone oil filling,and 1 eye attained reattachment after scleral pad pressure band adjustment again;11 eyes(22.00%,11/50)got a poor retinal reattachment:9 eyes of them had localized subretinal proliferative membrane,which were stable and untreated under long-term observation,and 2 eyes attained reattachment after vitrectomy and silicone oil filling.At the final follow-up,36 eyes(72.00%,36/50)had complete retinal reattachment after only one scleral buckling;41 eyes(82.00%,41/50)had final retinal reattachment,2 eyes of which were at the filling state of silicone oil;9 eyes(18.00%,9/50)improved.Visual acuity improved in 29 eyes(58.00%,29/50)and showed no significant change in 19 eyes(38.00%,19/50),and decreased in 2 eyes(4.00%,2/50).Conclusion Scleral buckling in the treatment for children and adolescents with special types of RRD is safe and effective,and can result in retinal reattachment which improved or stable vision in most affected eyes.