玻璃体切割联合巩膜扣带术治疗复杂性视网膜脱离扣带作用的评价

Effects of buckles in joining vitrectomy for complicated retinal detachment

目的 :探讨玻璃体切割联合巩膜扣带术治疗复杂性视网膜脱离中环扎带的作用。对巩膜扣带的作用与必要性做出评价。方法 :分析玻璃体切割联合巩膜扣带术的 34眼与玻璃体切割非联合巩膜扣带术 132眼的手术效果及环扎带对眼轴、视力的影响。结果 :玻璃体切割联合巩膜外环扎组 34眼 ,视网膜完全复位 2 4眼 ,复位率 70 5 8% ,非环扎组 132眼视网膜完全复位 10 3眼 ,复位率 78 0 3%。非环扎组视网膜解剖复位率高于环扎组 ,但无统计学意义 (P =0 62 2 )。术后视力改善者 ,环扎组 15眼占44 11% ;非环扎组 5 9眼占 44 6%。两组差别无统计学意义 (P =0 994)。环扎组术前平均轴长为 2 4 0 92 1± 2 2 197mm ,术后为2 5 985 4± 4 70 98mm ,差别有显著性差异 (P <0 0 5 )。非环扎组术前平均轴长为 2 4 5 45 6± 2 45 18mm ,术后为 2 5 5 2 5 6±4 372 0mm ,差别无显著性差异 (P >0 0 5 )。结论 :1 经玻璃体切割、剥膜、眼内充填的复杂性视网膜脱离病例 ,巩膜扣带无助于解剖复位率的提高。 2 彻底的PVR剥除配合必要的视网膜松解性切开 ,充分的激光或冷凝封孔 ,有效的眼内充填 ,是各种复杂性视网膜脱离复位的关键环节。

Objective:To determine if scleral buckling is of any additional benefit in repair of complicated retinal detachment with vitrectomy. Methods:166 eyes with complicated retinal detachment repaired with vitreous surgery combined with scleral buckling (34 eyes) or without scleral buckling (132 eyes) were studied.The long-term retina reattachment rate,ocular axial length,and visual acuity were examined. Results:Comparing the buckling group with non buckling group,no significant differences were found.In the buckling group and no buckling group,the total retina reattachment rates were 70 58% (24 eyes to 34 eyes) and 78 03% (103 eyes to 132 eyes),the improvements of postoperative corrected visual acuity were 44 11% (15 eyes to 34 eyes) and 44 6% (59 eyes to 132 eyes).In scleral bucking group,the average ocular axial length were 24 0921±2 2197mm preoperatively and 25 9854±2 4518mm postoperatively,respectively,and the differences were significant (P<0 05).In non buckling group,the average ocular axial length were 24 5656±2 4518mm and 25 5256±4 3720mm,respectively,but no differences were found (P>0 05). Conclusions:Scleral buckling may not be necessary in complicated retinal detachment if repaired with vitrectomy,peeling,endolaser photocoagulation and intraocular tamponade.Thorough peeling with relaxing retinotomy,sufficient photocoagulation or cryotherapy,and effective gas or silicone oil tamponade,are the keys to the surgery for complicated retinal detachment;the scleral buckling,however,is not requisite.