摘要
目的:比较常规扁平部三通道硅油取出术和既往两切口单纯硅油取出术的手术并发症,考察并评价其临床效果。方法:回顾性分析2001-04/2003-06以及2003-06/2006-11两个时期(分为两组)在本院行硅油取出术的临床连续病例。前组共78例(78眼),47例无晶状体眼采用角膜缘或角膜小切口取出硅油;7例有晶状体眼采用睫状体平坦部双切口取硅油;16例联合白内障手术者,常规行超声乳化或ECCE术,再撕开后囊膜,从前房白内障手术切口放出硅油;8例视网膜复位欠佳,或局部有增生膜者,硅油取出联合常规三通道玻璃体切除术。后组病例共113例(113眼),不论有无晶状体,全部病例均采用常规扁平部三通道取硅油,取油时联合切除残余玻璃体基底部、视网膜光凝及剥离视网膜前膜。硅油取出术后随访5mo～5a,平均随访时间为(2.7±2.1)a。结果:前组中共有3例发生脉络膜上腔出血(3.8%);15例发生视网膜再脱离(19.2%);8例眼压控制不良需加用降眼压药物(10.3%);12例出现低眼压(眼压<5mmHg)(15.4%);1例术后发生角膜内皮失代偿(1.3%);38眼视力提高2行以上(48.7%)。后组病例中未出现脉络膜上腔出血和新发角膜病变,11例发生视网膜再脱离(9.7%),与前组比较差异具有统计学意义(P<0.05)。7例眼压控制不良需加用降眼压药物(6.2%),15例出现低眼压(13.3%);58眼视力提高2行以上(51.3%)。结论:虽然两切口单纯硅油取出术方法简单,在几年前应用较为普遍,但术中不能做一些眼底的详细检查及适当处理;而常规扁平部三切口硅油取出可以联合玻璃体切割及膜剥离、激光光凝等操作,有助于保持视网膜复位和视功能提高,减少并发症的出现,具有广泛的临床应用价值。
AIM： To investigate the clinical effect and surgical complications of two methods of silicone oil removal, comparing conventional pars plana sclerotomy and past two incision for simple silicone oil removal.METHODS： The retrospective study included 191 eyes of 191 consecutive patients who underwent the removal of silicone oil in two periods, from April 2001 to June 2003 and from June 2003 to November 2006 （divided into two groups） in our hospital. In the first group of 78 cases （eyes）, silicone oil was removed through superior corneal limbal or corneal incision （transpupillary drainage of silicone oil） in 47 aphakic eyes, and through two pars plana sclerotomies in 7 phakic eyes. In 16 eyes combined with cataract surgery, phacoemulsification or extra-capsular cataract extraction （ECCE） was performed and then silicone oil was removed through a planned posterior capsulorhexis and the incision of cataract before implantation of posterior chamber intraocular lens. In 8 eyes with partial retinal reattachment, or with local proliferative membranes, silicone oil removal was combined with conventional three-channel pars plana vitrectomy. In the second group of 113 cases （eyes）, whether in aphakic eyes or phakic eyes, silicone oil was removed through three pars plana sclerotomies in all patients, combined with cutting remnants of the vitreous base, retinal photocoagulation, and stripping preretinal membrane. The follow-up period ranged from 5 months to 5 years, averaged （2.7±2.1 ） years. RESULTS. Suprachoroidal hemorrhage occurred in 3 eyes （3.8%） in the first group, retinal redetachment in 15 eyes （19. 2%） after removal of silicone oil. Intraocular pressure （IOP） was still high in 8 eyes （10.3%） which needed anti-glaucoma drugs. Ocular hypotension （IOL〈 5mmHg） occurred in 12 eyes （15. 4%）; corneal endothelial decompensation occurred postoperatively in 1 eye （1. 3%）. Visual acuity was improved two lines or more in 38 eyes（48.7% ）. In the second group, there was no suprachoroidal hemorrhage or new corneal lesions. Retinal redetachment occurred in 11 eyes （9.7%） after removal of silicone oil, and the difference was statistically significant compared with the first group （P〈0.05）. Intraocular pressure was still high in 7 eyes （6.2%）, ocular hypotension occurred in 15 eyes （13. 3%）, and visual acuity was improved two lines or more in 58 eyes （51.3%）. CONCLUSION： Although only two-incision method is simple for removal of silicone oil, which was used generally a few years ago, careful fundus examination and appropriate treatment cannot be done in the operation. While conven-tional three pars plana scleroto-mies for silicone oil removal can be combined with vitrectomy, membrane stripping and laser photocoagulation, which help maintain retinal reattachment, improve visual function and reduce complications, so it should have broad clinical applications.
出处
《国际眼科杂志》
CAS
2008年第1期167-170,共4页
International Eye Science
