Marfan综合征合并视网膜脱离的手术治疗

Surgical treatment of Marfan's syndrome with retinal detachment

目的 探讨Marfan综合征合并视网膜脱离在运用巩膜外扣压及玻璃体视网膜手术的解剖复位率和视功能恢复结果。方法 回顾性研究 3 0例 3 9眼Marfan综合征合并视网膜脱离的患者运用巩膜外扣压及玻璃体视网膜手术的解剖和视功能恢复结果。结果 术后随访 3～ 48个月 ,平均 18个月 ,首选巩膜外扣压术 8眼 ,5眼 ( 62 5 % )视网膜复位成功 ;首选玻璃体视网膜手术 3 1眼 ,2 8眼 ( 90 3 % )视网膜一次复位成功 ,视网膜未复位者 ,再次手术后视网膜均复位。视力 0 3以上 15眼 ( 3 8 2 % ) ,0 0 5～ 0 3者 18眼 ( 46 15 % )。结论 ①对于Marfan综合征患者的视网膜脱离 ,玻璃体视网膜联合手术在视网膜复位上有其优势。②晶状体囊内摘除以及在晶体囊袋内安置张力环等可引起对视网膜的牵引 ,而可致视网膜裂孔 ,甚至巨大裂孔。

Objective To investigate the vision outcomes and the ratio of ratina attachment in Marfan's syndrome with retinal detachment which were treated with scleral bucking or vitreoretinal surgery respectively.Methods The author retrospectively analyzed the surgical outcomes of dissection and function in Marfans syndrome with retinal detachment which were treated with scleral bucking or vitreoretinal surgical respectively.Results The patients were followed up for 3 to 48 months(average 18 months)after operation,8 eyes were first treated with scleral bucking,and retina attached in 5 eyes(62.5%);31 eyes were treated with vitreoretinal surgery,and ratina attached in 28 eyes(90.3%)in the first operation,ratina of the remaming eyes were attached in the second vitreoretinal surgery,the ratio of ratina attachment was 100%.The visual acuities of 15 eyes(38.2%)were above 0.3 and 18 eyes(46.15%) were 0.05 to 0.3.Conclusion ①Vitreoretinal surgery combined with scleral bucking has better advantage for the treatment of Marfan's syndrome with retinal detachment.②Intracapsular lens extraction and capsular tension ring implantation during phacoemulsification may lead to traction of retinal detachment,retina hole or even gaint tear.