孔源性视网膜脱离的玻璃体手术治疗

Vitrectomy in treatment of rhegmatogenous retinal detachment

本文对孔源性视网膜脱离的定义、发病机理、形成机制、临床表现及治疗方法特点进行了综述,目前对于孔源性视网膜脱离的治疗常用两种方法:①巩膜外顶压术。可使网膜得以复位,但有导致网膜下出血及术后感染等严重的并发症,有时还导致眼球循环障碍、角膜散光等与术后视力恢复有关的并发症。②玻璃体手术。优点在于手术中易检出网膜裂孔及切除与裂孔相关的玻璃体牵拉条索,同时可以在眼内确切地排除网膜下液使脱离迅速复位,而且利用光凝封闭裂孔,对裂孔损伤小,对那些术后必然发生晶状体进行性混浊的高龄患者同时进行玻璃体白内障手术。因此玻璃体手术不仅复位效果良好,而且迅速恢复良好的视机能,手术适应症不断扩大,对某些特殊类型孔源性视网膜脱离,玻璃体手术效果优于巩膜外顶压术。

The definition, pathogenesis, development mechanism, clinical manifestations and treatments of rhegmatogenous retinal detachment were reviewed. At present, 2 treatments are usually used. The first is scleral buckling with exoplant, which can correct the dislocation of retina, but unluckily, have some severe complications, such as subretinal hemorrhage, postoperative infection, eyeball circulation disorder, corneal astigmatism, et al. The second is vitrectomy. In vitrectomy, retinal hiatus can be found easily, vitreous traction streaks related to the retinal hiatus can be excised; the subretinal fluid can be eliminated efficiently so as to facilitate retinal reattach-ment; photocoagulation is used to seal up the hiatus, thus with little damage; cataract extraction can be performed simutaneously in the senile patients bound to develop progressive crystalloid turbidity after surgery. Vitrectomy can not only correct retinal dislocation effectively, but also improve visual function fast. So, it has more and more indications, including retinal detachments of some specific types, for which vitrectomy is superior to scleral buckling with exoplant