裂孔性视网膜脱离再手术原因及术式选择临床分析

The clinical analysis of rhegmatogenous retinal detachment reoperation

目的 :分析裂孔性视网膜脱离再手术原因 ,以及再手术选巩膜扣带术或玻璃体手术的指征。方法 :回顾 6 5只眼再手术病例 ,分析原手术方法及眼底改变。重点观察玻璃体病变的动态变化和增殖性玻璃体视网膜病变的发展。据此分别施行巩膜扣带术或玻璃体手术。结果 :再手术原因为原裂孔未封闭、新裂孔形成、玻璃体状态变化和增殖性玻璃体视网膜病变。与既往文献报告相同 ,因手术操作不当者比例下降 (15 4 % ) ,玻璃体牵引和后脱离动态变化比例上升 (44 6 %和 73 8% ) ,增殖性玻璃体视网膜病变加重者占 4 6 2 %。多次手术治愈 5 8只眼 (86 1% )。结论 :裂孔性视网膜脱离再手术仍首选巩膜扣带术 ,多行巩膜环扎加压。严重的增殖性玻璃体视网膜病变、中度病变但有明确的局部玻璃体状态变化及增殖性改变者行玻璃体手术。重视玻璃体 视网膜界面变化、玻璃体状况和玻璃体视网膜增殖性变化的局部特征 ,对症施行手术 ,可提高手术治愈率。

Objective:To study the reason and indications of reoperation of rhegmatogenous retinal detachment.Methods:Original operation methods and types of vitreoretinopathy were analyzed in 65 cases of reoperation.Accordingly,the second operation,which included scleral buckling operation or vitrectomy,was chosen and performed.Results:The reasons for reoperation were non-closed original breaks after operation,new breaks,vitreous change and proliferative vitreoretinopathy.The result is the same as that in other research reports:The percentage of improper operation was decreased(15.4%),vitreous retraction and posterior detachment was risen(44.6% & 73.8%),and deteriorate of proliferative vitreoretinopathy was 46.2%.Finally,58 eyes (86.1%) were cured under multioperation.Conclusion:Scleral buckling operation is still first choice for the patient with first surgery failure of rhegmatogenous retinal detachment.The vitrectomy is good for the patient of serious proliferative vitreoretinopathy.