方法：选取复杂视网膜脱离病例100例100眼，均病程≥1mo，合并下方周边视网膜裂孔，脱离区视网膜增殖、至少有一处皱襞。随机分成两组：治疗组50眼采取玻璃体切除联合下方巩膜外垫压治疗； 对照组50眼采取单纯玻璃体切除治疗，比较两组视网膜解剖复位、矫正视力、术后1wk黄斑中央凹厚度及术后并发症情况。

结果：治疗组视网膜解剖复位有49眼(98%)，对照组视网膜复位42眼(84%)，差异有统计学意义(χ² =4.2605，P<0.05)； 治疗组术后矫正视力：0.254±0.238，对照组术后最佳矫正视力：0.219±0.229，差异无统计学意义(t=1.8879，P>0.05)； 术后1wk，黄斑中央凹厚度：治疗组272±32.21μm，对照组316±33.46μm， 差异有统计学意义(t=12.597，P<0.01)； 术后1wk内治疗组共有12眼(24%)眼压超过30mmHg，对照组有4眼(8%)眼压超过30mmHg，差异有统计学意义(χ²=4.7619，P<0.05)，术后1mo两组患者眼压均能控制在21mmHg以下。

结论：对于复杂视网膜脱离，采取玻璃体切除联合下方巩膜外垫压治疗安全、操作准确，相对于单纯玻璃体切除手术更有助于术后视网膜的解剖复位和黄斑水肿的早期消退。

METHODS:The complex kind of retinal detachment were diagnosed in 100 cases(100 eyes), with the common features: 1)the course of more than 1mo; 2)at least one retinal hole located in the inferior marginal retina; 3)the detachment of retina was found proliferated, there was at least 1 retinal fold in retinal detachment area. The patients were randomly divided into two groups: the treatment group(50 eyes)who received vitrectomy combined with inferior scleral buckling; the control group(50 eyes)who received vitrectomy without scleral buckling. The retinal anatomic reattachment, visual function recovery, macular central fovea thickness and complications in two groups were observed.

RESULTS: There were 49 eyes(98%)with retinal anatomic reattachment in the treatment group while 42 eyes(84%)in control group(χ²=4.2605, P<0.05); the best corrected visual acuity(BCVA)was 0.254±0.238 in the treatment group while it was 0.219±0.229 in control group(t=1.8879,P>0.05); the macular central fovea thickness was 272±32.21μm in the treat group while it was 316±33.46μm(t=12.597,P<0.01). Intraocular pressure in 12 eyes(24%)was more than 30mmHg in the treatment group while 4 eyes(8%)in control group within 1wk postoperation(χ²=4.7619,P<0.05); intraocular pressure in 100 eyes were controlled below 21mmHg 1mo postoperatively.

CONCLUSION: It is a more effective method to vitrectomy combined with inferior scleral buckling than the single vitrectomy for the special kind of retinal detachment. It can increase the rate of retinal anatomic reattachment and reduce macular edema.