高度近视巨大裂孔视网膜脱离的临床观察

Ginical investigation to retinal detachment with a giant tear and high myopia

目的 观察高度近视患者巨大裂孔视网膜脱离(retinal detachment with a giant tear,RDWGT)的手术疗效。方法 回顾性分析我院自2000年10月至2002年10月手术治疗高度近视患者RDWGT9例(10眼)。2例2眼行环扎、放液、外加压、冷冻术;7例(8眼)行标准三通道式玻璃体切除联合剥膜、全氟萘烷注入、眼内光凝及硅油注入,其中2例2眼联合巩膜环扎。术后均全身应用激素。结果 术后随访6～20个月(平均12.6个月),7例(8眼)视网膜完全复位(80.0％),未复位2例(2眼)均为外路手术;术后最终矫正视力光感-指数者1眼,视力为0.01～0.05者2眼,0.06～0.1者2眼,0.2～0.5者3眼,0.6～1.0者2眼;与术前相比,视力提高6眼,视力不变4眼。结论 高度近视RDWGT应首选玻璃体视网膜手术,效果显著,术中可以不进行巩膜环扎术。玻璃体视网膜术后使用皮质激素有助于预防术后增殖性玻璃体视网膜病变的发生。

Objective To study the surgical effects of retinal detachment with a giant tear (RDWGT)in high myopia patients. Methods Retrospective analysis 9 (10 eyes) RDWGT and high myopia patients who underwent operations at Beijing Friendship Hospital from October, 2000 to October, 2002, Scleral bucking with drainage of subretinal liquid was performed on 2 patients ( 2 eyes) . A standard three - point vitrectomy with peri - retinal membrane resection, perfluro - n - octane intraoperative retinal tamponade and intraocular photoagulation was performed on 7 patients (8 eyes), scleral buckling was also performed on 2 patients (2 eyes) . After operation, corticosteroid was generally used. Results In the follow - up for 6 - 20 months (mean 12.6months), total retinal attachment was achieved in 7 patients (8 eyes) (80.0%). Retina were not attached in 2 patients (2 eyes) who underwent scleral buckling with drainage of subretinal liquid. The final visual acuities were light perception - CF in 1 eye, 0.01 - 0.05 in 2 eyes, 0.06 - 0.1 in 2 eyes, 0.2 - 0.4 in 3 eyes, 0.6 - 1.0 in 2 eyes. Postoperative visual acuity improved in 6 eyes, remained stable in 4 eyes. Conclusion RDWGT concomitant high myopia should select vitrectomy at first. The surgical effects are good. Scleral budding is not needed during surgery. The administration of corticosteroid is beneficial to the prophylaxis of PVR.