复杂孔源性视网膜脱离玻璃体手术治疗分析

Vitreoretinal surgery for complicated rhegmatogenous retinal detachment

目的 评价玻璃体手术治疗复杂孔源性视网膜脱离的疗效 ,并对影响疗效的相关因素及并发症进行分析。方法 对 10 3例复杂孔源性视网膜脱离随访资料完整的病例进行回顾性研究。术前 <0 0 2视力 70眼 ( 67 96% ) ,≥ 0 .0 2视力 3 3眼 ( 3 2 0 4% ) ;其中黄斑裂孔 2 1眼 (伴PVR C2以上 12眼 )、巨大裂孔 11眼、其它孔源性视网膜脱离PVRC2级以上71眼 (其中C2级 15眼、C3级 12眼、D1级 13眼、D2级 13眼、D3级 18眼 )。发病至手术时间 :≤ 14d 8眼 ,15～ 3 0d 10眼 ,1～ 3个月 3 7眼 ,3～ 6个月 2 4眼 ,≥ 6个月 2 4眼。采用常规睫状体平部三通道玻璃体切割手术 ,根据情况联合进行了晶体切除、巩膜外环扎、视网膜切开、视网膜切除、视网膜下膜取除等操作 ;82眼行C3F8填充 ,2 1眼行硅油填充。随访 3～18个月。结果 视网膜复位 99眼 ,4眼复位失败 ;视力提高 73眼 ( 70 87% ) ,矫正视力 <0 0 2 ,3 5眼 ( 3 3 98% ) ,≥ 0 0 2 ,68眼 ( 66 0 2 % ) ,其中 0 0 2～ 0 0 8,18眼、0 1～ 0 4,3 9眼、0 5～ 0 9,10眼、≥ 1 0 ,1眼。结论 玻璃体手术是治疗复杂性视网膜脱离的有效方法 ;尽早行手术治疗可获得更好的术后结果 ;提高手术技巧、加强术后随访及处理是减少术后并发症 。

Objective To evaluate the efficacy of vitreoretinal surgery for the treatment of complicated rhegmatogenous retinal detachment and to study the correlated factors affecting the surgical outcomes. Methods Complete follow up data from 103 patients (eyes) with complicated rhegmatogenous retinal detachment treated with vitreoretinal surgery were analyzed retrospectively. Conditions of the eyes included macular hole in 21 eyes [with proliferative vitreoretinopathy (PVR) stage C2 or more serious in 12 eyes], giant hole in 11 eyes, and PVR stage C2 to D3 in 71 eyes. Filling with C3F8 was performed in 82 eyes, and silicone oil in 21 eyes. A follow up for 3-18 months was conducted. Results The reattachment of retina was achieved in 99 eyes (96.1%) and functional success in 68 eyes (66.0%). In eyes with functional success, visual acuity of 0.02-0.08 was achieved in 18 eyes, 0 1-0 4 in 39 eyes, 0.5-0.9 in 10 eyes, and 1.0 in 1 eye. Conclusion Vitreoretinal surgery is an effective way for the management of complicated rhegmatogenous retinal detachment. Early surgery may result in satisfactory surgical outcomes.