复发性黄斑裂孔视网膜脱离的临床分析

Clinical Analysis of Recurrent Macular Holes in Eyes with Retinal Detachment

目的探讨黄斑裂孔视网膜脱离复发的原因以及再次手术治疗的效果。 方法回顾分析14例(14只眼)黄斑裂孔视网膜脱离第一次玻璃体手术后复发的原因以及再手术后的效果。 结果14例复发性黄斑裂孔视网膜脱离眼中,7例存在黄斑前膜,占50％;2例黄斑白孔及气体量不足2例;前部增殖性玻璃体视网膜病变、视网膜新裂孔及体位不正确各1例。再次玻璃体手术后,随访3个月以上,3例失随访,余11例中解剖复位成功者9例,占81.8％,其中视力提高者6例,占66.7％。 结论黄斑裂孔视网膜脱离玻璃体手术后复发原因主要由黄斑前膜造成。再次玻璃体手术仍是治疗复发性黄斑裂孔视网膜脱离的有效手段。

Objective To investigate the causes of recurrent macular holes with retinal detachments and the therapeutic efficiency of reoperation. Methods The causes of postvitrectomy recurrent macular holes with retinal detachment in 14 patients ( 14 eyes) and the therapeutic efficiency of reoperations were analysized. Results In the 14 recurrent macular holes with retinal detachment, epimacular membranes were found in 7 eyes (50% ) ; 2 patients (14. 3% ) had macular holes with atrophia of RPE and choroidal; in 2 patients (14.3% ) there was insufficent gas in the vitreous cavity. 1 patient (7. 1% ) had anterior PVR, 1 patient (7. 1% ) had a new tear in the retina, and another patient (7. 1% ) it was due to incorrect posture. Conclusion The main cause of postvitrectomy recurrent macular holes with retinal detachment was epimacular membrane formation. But macular holes with atrophia of RPE and choroidal, insufficent gas in the vitreous cavity, anterior PVR, new retinal tear and incorrect posture were causes too. Reoperation is still the effective method for treating recurrent macular holes with retinal detachment.