激光光凝治疗黄斑未受累的孔源性视网膜脱离

Laser Photocoagulation for Macula-sparing Rhegmatogenous Retinal Detachments

目的总结激光光凝治疗黄斑未受累的孔源性视网膜脱离的经验和疗效。方法间接眼底镜和三面镜检查确诊为黄斑未受累的孔源性视网膜脱离18例19眼,均为浅脱离。采用氩激光光凝脱离的视网膜。沿脱离区与非脱离区边缘行1排激光光凝,向正常视网膜和脱离区一侧分别行2～3排激光光凝。激光光斑直径100～200μm,功率100～500mW,时间0.1～0.3s。1周后行第2次激光光凝,直至脱离的视网膜复位。所有病人均在门诊局部麻醉下进行治疗。随访2～13个月。结果19眼中16眼治愈,治愈率为84.2%;未治愈3眼,占15.8%。视网膜脱离范围1/2～2个时钟,脱离位于上方象限10眼,下方象限7眼,颞侧2眼。圆孔12眼,马蹄形裂孔7眼。相关的眼部检查结果包括视网膜格子样变13眼,玻璃体出血4眼和近视8眼。激光治疗未复位的3眼中,1眼经玻璃体切割,2眼经巩膜外加压手术后视网膜复位。随诊观察激光光凝后玻璃体出血吸收,视网膜表面或局部玻璃体未见增殖。结论对于视网膜表面光滑,无皱折,不伴有增值性玻璃体视网膜病变,呈局限性浅脱离状态的急性或慢性黄斑部未受累的孔源性视网膜脱离,激光光凝效果好,成功率较高,并发症较少。

Objective To report a series of macula -sparing rhegmatogenous retinal detachment s(MSRRDs )treated with laser photocoagulatio n.Methods Macula -sparing rhegmatogenous retinal detachments were diagnosed in e ighteen patients(19eyes)by indirect ophthalmo-scope and 3-mirror contact lens.Photocoagulation was performed in the r egions between detached and nondeta ched retinas,and 2-3rows of confluent laser burns were done in the sides of the detached and non detached retinas respectively usin g 100-500mW,100-200μm,0.1-0.3s.One week later,laser photocoagulation was performed again until retinas were reattached.All p atients were treated with local anesthesia in an o utpatient setting.Follow -up range d from 2to 13months.Results Retinal detachments were initially achieved in 16(84.2%)of 19eyes after laser photocoagulation.The area of MSRRDs ranged from 1/2to 2clock -hours of th e retina,and located in superior(n=10),inferior(n=7)or temporal(n=2)sides re-spectively.Type of tears included r ound hole(n=12)and horseshoe tear(n=7).Ocular symptom also included latti ce degeneration in 6eyes,limited vitreous hemorrhage in 4eyes.Myopia was diagnosed in 8eyes.Three eyes were failed by initi al treatment,but the retinal reattachments were achieved finally by scleral depression in on e eye and vitrectomy in two eyes.During follow -up period,vit-reous hemorrhage was absorbed,and p roliferation of retinas and vitreou s were not noted.Conclusions Laser photocoagulation is an effective method to manage acute or chronic,primary MSRRDs without associated prolif-erative vitreoretinopathy(PVR)that are shallow and smooth without c orrugations,its use can be recommen ded because of the relatively high rate of success and lower risk of complications.