中华眼底病杂志

中华眼底病杂志

25G光纤内照明辅助巩膜扣带手术治疗单纯孔源性视网膜脱离

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目的 观察25G光纤内照明辅助巩膜扣带手术治疗孔源性视网膜脱离(RRD)的疗效及安全性。 方法 回顾性病例对照研究。临床检查确诊的RRD患者57例57只眼纳入研究。患者中,男性35例35只眼,女性22例22只眼。将患者随机分为间接镜组和内照明组,分别为29例29只眼、28例28只眼。两组患者性别构成比、平均年龄、平均病程、外伤史、近视、人工晶状体眼数、白内障眼数、最小分辨角对数(logMAR)最佳矫正视力(BCVA)、平均眼压、裂孔数量、是否累及黄斑、是否伴有变性区眼数、裂孔位置、平均视网膜脱离时钟位数比较,差异均无统计学意义(P>0.050)。间接镜组患眼采用传统双目间接检眼镜观察眼底完成巩膜扣带手术;内照明组患眼通过25G光纤插入玻璃体腔,利用手术显微镜非接触广角系统观察眼底完成视网膜冷冻及裂孔定位。手术后随访6~12个月。观察患眼BCVA、眼压、视网膜复位以及并发症发生情况。 结果 间接镜组、内照明组患眼手术时间比较,差异有统计学意义(t=2.124,P=0.031)。间接镜组29只眼中,视网膜复位26只眼,占89.7%;未复位3只眼,占10.3%。内照明组28只眼中,视网膜复位26只眼,占92.8%;未复位2只眼,占7.2%。两组患眼视网膜复位率比较,差异无统计学意义(P=1.000)。视网膜未复位的5只眼中,再次行巩膜扣带手术3只眼;玻璃体切割手术联合硅油填充2只眼。手术后视网膜均复位。两组患眼最终视网膜复位率均为100.0%。两组患眼logMAR BCVA均较手术前提高,差异有统计学意义(t=4.529、5.108,P<0.001);两组患眼之间logMAR BCVA比较,差异无统计学意义(t=0.559,P=0.458)。两组患眼眼压与手术前比较,差异无统计学意义(t=−1.386、−1.437,P=0.163、0.149)。两组患眼之间眼压比较,差异无统计学意义(t=0.277,P=0.730)。间接镜组29只眼中,发生视网膜下出血1只眼;两组患眼均未发生医源性视网膜裂孔、脉络膜上腔出血、感染性眼内炎等手术并发症。 结论 25G光纤内照明辅助巩膜扣带手术时间短,安全有效。

Objective To evaluate the effectiveness and safety of 25G illumination aided scleral buckling surgery for treatment of rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case control study. Fifty-seven RRD patients (57 eyes) were enrolled in this study. There were 35 males (35 eyes) and 22 females (22 eyes). The patients were randomly divided into ophthalmoscope group (29 patients, 29 eyes) and illumination group (28 patients, 28 eyes). There was no differences in the data of gender, age, onset time, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity(BCVA) and information of retinal tears between the two groups (P>0.050). The patients in the ophthalmoscope group received operation of conventional scleral buckling with binocular indirect ophthalmoscope. The patients in the illumination group received scleral buckling surgery with the aid of intraocular illumination and noncontact wide-angle viewing system. The follow-up was ranged from 6 to 12 months. The BCVA, intraocular pressure, fundus examination and complications were observed and recorded. Results The difference of operation time between two groups was significant (t=2.124, P=0.031). In the ophthalmoscope group, 26 eyes (89.7%) achieved retinal reattachment, 3 eyes (10.3%) failed in retinal reattachment. In the illumination group, 26 eyes (92.8%) achieved retinal reattachment, 2 eyes (7.2%) failed in retinal reattachment. There was no difference of retinal reattachment rate (P=1.000). Five eyes failed in retinal reattachment, 3 eyes received sclera buckling surgery, 2 eyes received vitrectomy with silicone oil tamponade. The final reattachment ratios were both 100%. BCVA increased in both groups compared with pre-surgery BCVA (t=4.529, 5.108; P<0.001). The difference of BCVA between two groups was not significant (t=0.559, P=0.458). There was no significant difference of intraocular pressure and complications before and after surgery in both two groups (t=−1.386, −1.437; P=0.163, 0.149). The difference of intraocular pressure between two groups was not significant (t=0.277, P=0.730). Subretinal hemorrhage occurred in 1 eye in the ophthalmoscope group. There was no iatrogenic retinal break,  choroidal hemorrhage and endophthalmitis in the two groups. Conclusion 25G intraocular illumination aided buckling surgery for treatment of RRD is fast, safe and effective.

关键词: 视网膜脱离/外科学; 巩膜扣带术

Key words: Retinal detachment/surgery; Scleral buckling

引用本文: 赵通, 陈酉, 孙川, 王志军. 25G光纤内照明辅助巩膜扣带手术治疗单纯孔源性视网膜脱离. 中华眼底病杂志, 2017, 33(4): 383-386. doi: 10.3760/cma.j.issn.1005-1015.2017.04.013 复制

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