孔源性视网膜脱离术后复发的原因分析及处理

Cause analysis and management of redetachment after rhegmatogenous retinal detachment operation

目的分析孔源性视网膜脱离术后复发的原因及处理方法。方法横断面研究。对2020年1月至2022年8月成都爱迪眼科医院收治的148例(148眼)行孔源性视网膜脱离修复术后视网膜再脱离病例进行分析。观察再脱离原因及临床特点选择不同手术方式进行治疗。结果148例(148眼)中再次玻璃体切除术者116眼,行巩膜扣带术者32眼。再次手术后,视网膜一次性复位118眼(79.73%)。未复位30眼(20.27%),其中16眼(53.33%)放弃进一步治疗,14眼再次手术(46.70%),复位12眼(85.70%),仍未复位2眼(14.29%)。复位者视力均不同程度提高。总复位130眼(87.84%)。再脱离病例原因分为7类:原裂孔封闭不良30眼(20.27%),遗漏裂孔28眼(18.92%),出现新裂孔21眼(14.20%),严重增生性玻璃体视网膜病变(PVR)35眼(23.65%),穿刺口玻璃体处理不彻底19眼(12.83%),手术方式选择不当6眼(4.05%),术前、术中未发现确切裂孔、再脱离原因不明9眼(6.08%)。结论术前准确查找、术中完全封闭裂孔,彻底切除玻璃体和松解PVR,选择合理的术式,大多数复发性视网膜脱离患者经再次手术治疗后视网膜复位、视力提高。

Objective To analyze the causes and management of redetachment after rhegmatogenous retinal detachment surgery.Methods This was a cross-sectional study.A total of 148 eyes of 148 patients with rhegmatogenous retinal detachment who underwent repair surgery in Chengdu Aidi Eye Hospital from Jan.2020 to Aug.2022 were included in this study.The causes of redetachment and clinical characteristic were observed,and the patients were treated with different surgical methods.Results Secondary vitrectomy was performed in 116 of 148 eyes and scleral buckling in 32 eyes.After reoperation,the retina was re-attached in 118 eyes(79.73%),and 30 eyes(20.27%)were not re-attached,among which 16 eyes(53.33%)gave up reoperation,14 eyes(46.70%)were re-operated with a result of 12 eyes(85.70%)re-attached and 2 eyes(14.29%)not re-attached.Visual acuity of the re-attached eyes improved with different degrees.Total re-attachment achieved in 130 eyes(87.84%).There were 7 main reasons for the redetachment cases:insufficient retinopexy in 30 eyes(20.27%);missing retinal tearing in 28 eyes(18.92%);new tearing in 21 eyes(14.20%);severe proliferative vitreoretinopathy(PVR)in 35 eyes(23.65%);incomplete vitrectomy puncture in 19 eyes(12.83%);improper surgical method selection in 6 eyes(4.05%)and retina detached with unknown causes in 9 eyes(6.08%)with no exact tearing found before or during operation.Conclusion By finding the holes accurately and treating them sufficiently,performing complete vitrectomy and releasing of PVR as much as possible with reasonable selection of surgical procedure,retinal re-attachment with improved visual acuity for most patients with recurrent retinal detachment is achieved after re-operation.