巩膜加压术治疗玻璃体切割术后复发性视网膜脱离的疗效和安全性评价

Efficacy and safety of scleral buckling for recurrent retinal detachment after vitrectomy

目的观察巩膜加压术治疗玻璃体切割术(PPV)后复发性视网膜脱离(re-RD)的疗效及安全性。方法将孔源性视网膜脱离经PPV治疗后发生re-RD的患者14例(14只眼)纳入研究,其中硅油填充眼re-RD 6只眼(42.86%),取油术后re-RD 8只眼(57.14%),14只眼增生性玻璃体视网膜病变(PVR)分级均为B级,均发现视网膜裂孔,13只眼(92.86%)视网膜脱离范围<3个象限。所有患者行巩膜加压术,术后随访至少6个月,随访期间硅油填充眼完成取油手术,评估视网膜复位情况、术后最佳矫正视力及术后并发症情况。结果截至末次随访,所有患者视网膜均复位,术后最佳矫正视力明显提高,从术前(0.91±0.75)LogMAR提高到术后(0.60±0.34)LogMAR,P<0.05。2例(14.29%)硅油填充眼患者术后出现高眼压,使用降眼压药治疗后眼压恢复正常,取油后停用降眼压药,随访期间眼压正常。2例(14.29%)患者术后出现黄斑囊样水肿,经局部激素治疗后黄斑水肿消退。术后无脉络膜脱离、眼前段缺血、加压块感染、眼内炎、复视等并发症。结论巩膜加压术是治疗PPV术后re-RD安全、有效的方法,尤其适用于PVR<C级、裂孔明确、视网膜脱离范围<3个象限的患者。

Objective To study the efficacy and safety of scleral buckling in the treatment of recurrent retinal detachment(re-RD)after vitrectomy.Methods Retrospective review of medical records was performed on 14 patients(14 eyes),who underwent pars plana vitrectomy(PPV)for rhegmatogenous retinal detachment and were treated with scleral buckling after re-RD.Among these,6 eyes(42.86%)had re-RD with silicone oil(SiO)tamponade and re-RD were found in 8 eyes(57.14%)after silicone oil removal.All patients had proliferative vitreoretinopathy(PVR)B and retinal breaks,and retinal detachment was found<3 quadrants in 13 eyes(92.86%).The follow-up period was at least 6 months.The final anatomical and functional outcomes,as well as postoperative complications were analyzed.Results At the last follow-up,all 14 eyes achieved total retinal reattachment.The postoperative best-corrected visual acuity(BCVA)improved significantly(P<0.05)from preoperative BCVA(0.91±0.75)LogMAR to postoperative BCVA(0.60±0.34)LogMAR.Two patients(14.29%)with SiO-filled eyes developed elevated intraocular pressure after surgery,which normalized with the use of medication and remained normal during the follow-up period after SiO removal.Two patients(14.29%)developed postoperative macular cystoid edema,which resolved with topical glucocorticosteroid treatment.There were no complications such as choroidal detachment,ocular anterior segment ischemia,buckle infection,endophthalmitis or diplopia in the postoperative period.Conclusion Scleral buckling can be effective and safe in the treatment of re-RD after vitrectomy,especially for patients with PVR less than grade C,well-defined retinal breaks,and retinal detachment<3 quadrants.