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[摘要]
目的:观察巩膜外垫压术对孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的疗效。
方法:选取2008-05/2014-05在我院接受巩膜外垫压术治疗RRD的215例215眼患者的临床资料进行回顾性研究和分析。所有纳入研究的患眼必须达到确诊RRD的标准且增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)评级均在B级及以下。所有患眼术中均在双目检眼镜直视下行裂孔定位及巩膜外冷凝。随访至少2mo,术后观察视网膜的解剖复位、术后视力、术后并发症。
结果:术中行视网膜下液(subretinal fluid,SRF)引流者107眼(49.8%),82眼(38.1%)在手术结束时向其玻璃体腔注入无菌空气。接受单次巩膜外垫压术达到视网膜解剖复位并随访2mo以上无复发者196眼(91.2%),视网膜未能Ⅰ期复位者19眼(8.8%)。与术前相比较,术后视力提高192眼(89.3%),视力不变14眼(6.5%),视力下降9眼(4.2%)。没有因SRF引流和玻璃体腔注入无菌空气而产生相关并发症。发生手术相关并发症的患眼共有11眼(5.1%)。
结论:巩膜外垫压术治疗RRD安全有效,准确的裂孔定位及裂孔与垫压嵴的关系是手术成功最重要的因素。
[Key word]
[Abstract]
AIM: To evaluated the anatomic and functional outcomes of scleral buckling(SB)in a group of patients with rhegmatogenous retinal detachment(RRD)in this retrospective study.
METHODS: A total of 215 patients(215 eyes)with RRD underwent SB surgery from May 2008 to May 2014 by a single surgeon. All the patients were identified as fulfilling the criteria of presenting with a rhegmatogenous retinal detachment and the levels of proliferative vitreoretinopathy(PVR)were less than B. Localization and cryotherapy of retinal breaks in all eyes were performed with binocular indirect ophthalmoscopy during the operations. The main outcome measure was the primary reattachment rate at 2mo after single surgery. Patients were followed up for 2mo at least to observe the anatomic outcomes, postoperative vision and complications.
RESULTS: Subretinal fluid(SRF)drainage was performed in 107 eyes(49.8%), intravitreal injection of sterile air was fulfilled in 82 eyes(38.1%). The anatomical success rate after single SB surgery at 2mo was 91.2%(196/215), single SB surgery failed to retinal reattachment in 19 cases(8.8%). Compared with pre-operation, visual acuity increased in 192 cases(89.3%), unchanged in 14 cases(6.5%), decreased in 9 cases(4.2%). No complications related to SRF drainage and intravitreal injection of sterile air occurred. Only 11 patients experienced SB surgery- related complications.
CONCLUSION: SB surgery for RRD is safe and effective. Accurate localization of retinal breaks and the relationship between the retinal breaks and the pad edge are the most important factors for successful operation.
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