玻璃体视网膜手术治疗复杂性外伤性视网膜脱离的初步探讨

Primary exploration of treating complicated traumatic retinal detachment by vitreoretinal surgery

目的 探讨玻璃体视网膜手术 (vitreoretinal surgery,VRS)治疗复杂性外伤性视网膜脱离的疗效。方法 回顾性分析 1998年 2月～ 2 0 0 2年 5月行 VRS联合过氟化碳液体、视网膜切开和硅油填充术等技术治疗的复杂性外伤性视网膜脱离 (retinal detachment,RD) 4 7例 (4 7只眼 ) ,其中男 4 3例 ,女 4例 ,年龄 10～ 5 1岁 ,平均 (30 .3± 11.0 )岁。 17只眼继发眼球穿孔伤缝合术后 ,30只眼继发眼球钝挫伤 ,9只眼合并眼内异物。患者的 RD时间从 6小时至 2年 ,平均 (1.8± 4 .1)月。所有患者都有外伤性增生性玻璃体视网膜病变 (proliferative vitreoretinopathy,PVR)和前 PVR,PVR均在 C3级以上。 4 7只眼经一次性手术视网膜复位 2 3只眼 (4 8.9% ) ,另 2 4只眼在 VRS后因出现视网膜前膜或 RD,在术后 6～ 8周分别再次行 VRS或巩膜扣带术 (scleral buckling surgery,SBS)等 2次以上手术 ,其中再次行硅油下剥膜术 16只眼。术后随访 3～ 2 7月 ,平均 9.5月。结果 视网膜完全解剖复位 4 2只眼 ,部分复位 3只眼 ,失败 2只眼 ,总有效率 95 .7%。术后视力提高者 32只眼 (6 8.1% ) ;0 .0 1以上视力 2 9只眼 (6 1.7% )。10只眼采用 m ERG检测比较 ,有 6只眼术后总反应密度较术前有所提高。硅油填充术 4 1只眼 ,3～

Objective To observe effects of vitreoretinal surgery (VRS) on complicated traumatic retinal detachment.Methods Cases of 47 eyes (47 patients,43 men and 4 women,aging from 10 to 51 years,mean±standard deviation age of 30.3±11.0 years) having complicated traumatic retinal detachment and undergoing VRS with perfluorocarbon liquid,retinal section and silicon oil etc.between febuary 1998 and May 2002 were retrospectively reviewed.Included were 17 eyes followed by penetrating injury sutura,30 eyes followed by ocular contusion and 9 eyes combined with introcular foreign bodies.The duration of the patients' retinal detachment ranged from 6h to 2y,mean±standard deviation time of 1.8±4.1mo.All the eyes suffered from proliferative vitreoretinopathy (PVR) and previous PVR with PVR grade C 3 or more.23 of the 47 patients (48.9%) had total reattachment of theretina after one operation.In the other 24 eyes retinal frontal membrane or retinal detachment occured after VRS,so further operation such as VRS or SBS was performed again on them respectively during the 6 to 8 weeks postoperatively,involving peeling membrance in silicon oilin 16 eyes.The operative follow-up ranged from 3 to 27mo with an average of 9.5mo.Results The retina was attached completely in 42 eyes,partly in 3 eyes and never in 2 eyes.The total effect rate was 95.7%.The sight was improved in 32 of 47 eyes (68.1%),including 29 eyes (61.7%) with sight of over 0.01.At 3 to 15mo (mean time of 6.5mo) postoperatively,in 30 of the 41 eyes filled with silicone oil,the oil was taken out.During the follow-up period from 3 to 9mo,25 eyes had reattachment of the retina;4 eyes had a recurrence of retinal detachment and were performed VRS together with filling silicone oil;atrophy was found in 1 eye.Both penetration injury of eyeball had condensation increased PVR obviously compared with ocular contusion andocular laser (P<0.005).Conclusion VRS in combination with perfluorocarbon liquid,retinal section and silicon oil etc.can rebuild traumatic eyeball,reattach RD and recover sight.