摘要
目的由解剖和视功能疗效评价无扣带玻璃体手术治疗较复杂的非增殖型裂孔性视网膜脱离的应用价值及其优势。方法选择无明显PVR裂孔性视网膜脱离63例63眼,针对大小、形态、分布等较复杂的撕裂孔,行玻璃体切割、巩膜外冷凝及眼内气体充填,均无外加压。随访11～25个月,以视力、眼底彩照及术后OCT为主要评价指标。结果确诊赤道前后裂孔108个,其中术中发现25个。一次性手术视网膜复位率95.2%(60/63),最终达100%。无术后PVR发生。术后最佳矫正视力62例不同程度提高,79.4%达0.4以上,且恢复快。OCT检查术后3个月黄斑区形态,仅37.7%(20/53)有隐匿的结构异常,其中黄斑前膜对视力有轻度影响(p=0.020)。白内障发生率23.8%(15/63)且与年龄正相关(p=0.024)。结论在技术条件允许时,首选无扣带玻璃体手术治疗非增殖型较复杂裂孔性视网膜脱离,有利于提高一次性手术复位率和视功能恢复的程度及速度,并减少并发症。
Objective To assess clinical value of primary vitreoretinal surgery without scleral buckling for less complicated rhegmatogenous retinal detachment （RRD）, anatomically and functionally. Metheds A prospective analysis was carried out of 63cases（63 eyes） in RRD who underwent standard pars plana vitrectomy, cryotherapy and gas endotamponade as the initial procedure for the unusual size, shape, location, amount of the tears, with particular focus on no usage of additional scleral buckling. During 11 to 25 months follow-up, vision, fundus photodocumentation and Optical coherence tomography （OCT） were measured. Results Finally 108 retinal holes were definitely diagnosed, in which 25 missing ones were detected through internal search. The one-operation reattachment rate was 95.2%（60/63）, and finally reached 100%. Postoperative PVR occurred in none. Best corrected visual acuity improved in all, with 79.4% achieved 0.4 or better. OCT findings in 3 months postoperative show 37.7%（20/53） had abnormal macular morphology anonymously, and only the postoperative VA with epimacular membrane were slightly less than normal ones（p=0.020）. Postoperative cataract formation and progression occurred in 23.8%（15/63） and noted in elder patients. Conclusions With the development of surgical techniques and novel instrument, it is an effective even optimal procedure of primary vitreous surgery without scleral buckling for the non-PVR less complicated RRD, to increase single-operation anatomic and visual success with less complications.
出处
《中国实用眼科杂志》
CSCD
北大核心
2006年第7期710-714,共5页
Chinese Journal of Practical Ophthalmology
基金
广州市科技局科技攻关计划项目(2004Z3-E0511)
