中华眼底病杂志

中华眼底病杂志

微创玻璃体切割手术联合改良脉络膜上腔引流治疗脉络膜脱离型视网膜脱离的疗效观察

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目的 观察微创玻璃体切割手术(MIV)联合改良脉络膜上腔引流治疗脉络膜脱离型视网膜脱离(RRDCD)的疗效。 方法 前瞻性临床研究。临床检查确诊的RRDCD患者27例27只眼纳入研究。其中,男性16例,女性11例;均为单眼。平均年龄(53.67±14.82)岁;平均眼压(8.20±2.10)mmHg(1 mmHg=0.133 kPa);平均最小分辨角对数(logMAR)最佳矫正视力(BCVA)为1.87±0.58。所有患眼均行23G MIV联合改良脉络膜上腔引流手术,手术中利用1 ml注射针头和23G穿刺套管进行微创脉络膜液体引流。手术后随访3个月,观察手术后1、10 d,1、3个月的BCVA、眼压、视网膜复位率及手术并发症等情况。 结果 手术后1、10 d,1、3个月平均logMAR BCVA分别为1.62±0.67、1.51±0.63、1.39±0.54、1.32±0.56;平均眼压分别为(13.47±5.06)、(14.43±4.09)、(14.89±4.30)、(15.38±3.37)mmHg。与手术前logMAR BCVA、眼压比较,差异均有统计学意义(F=6.19、15.21,P<0.05)。手术后1、10 d所有患眼视网膜均复位良好,占100.0%;手术后1、3个月,视网膜复位良好者为24、23只眼,分别占88.9%、85.2%。随访期间未发生感染性眼内炎、脉络膜上腔出血等严重手术并发症。 结论 MIV联合改良脉络膜上腔引流手术治疗RRDCD可提高患眼裂孔闭合率,改善视力;治疗RRDCD安全有效。

Objective To observe the clinical effect of minimally invasive vitreoretinal (MIV) surgery combined with a modified suprachoroidal drainage surgery for retinal detachment associated with choroidal detachment (RRDCD). Methods A prospective clinical study. A total of 27 patients (27eyes) diagnosed as RRDCD were recruited in this study. There were 16 males and 11 females, with an average of (53.67±14.82) years. The mean intraocular pressure (IOP) was (8.2±2.1) mmHg (1 mmHg=0.133 kPa) and best corrected visual acuity (BCVA) of minimum resolution angle logarithm (logMAR) was 1.87±0.58. All subjects underwent 23G MIV combined a modified suprachoroidal drainage surgery, which 23G stab knife and 1 ml syringe needle were used for surgery. The visual outcome, IOP, rate of retinal reattachment and complications were comparatively analyzed preoperatively and postoperatively. Results At 1 day, 10 days, 1 month and 3 months after surgery, the average of logMAR BCVA were 1.62±0.67, 1.51±0.63, 1.39±0.54, 1.32±0.56 and the mean of IOP were (13.47±5.06), (14.43±4.09), (14.89±4.30), (15.38±3.37) mmHg, respectively. There were significant differences of logMAR BCVA and IOP between before and after surgery (F=6.19, 15.21; P<0.05). Retinal reattachments were achieved in 27 eyes (100%) at 1 day and 10 days after surgery. At 1 month and 3 months after surgery, the rate of retinal reattachment were 88.89% (24 eyes) and 85.19% (23 eyes), respectively. No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits. Conclusion MIV combined with a modified suprachoroidal drainage surgery is an effective and safe treatment for RRDCD, which can promote retina tear closure, improve visual acuity.

关键词: 视网膜脱离/外科学; 玻璃体切除术; 治疗结果

Key words: Retinal detachment/surgery; Vitrectomy; Treatment outcome

引用本文: 高韶晖, 路小楠, 栗占荣, 裴晗, 赵朝霞, 郭希让, 李蕴随. 微创玻璃体切割手术联合改良脉络膜上腔引流治疗脉络膜脱离型视网膜脱离的疗效观察. 中华眼底病杂志, 2018, 34(2): 116-119. doi: 10.3760/cma.j.issn.1005-1015.2018.02.003 复制

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1. Yu M, Wu Z, Zhang Z, et al. Metabolomic analysis of human vitreous in rhegmatogenous retinal detachment associated with choroidal detachment[J]. Invest Ophthalmol Vis Sci, 2015, 56 (9): 5706-5713. DOI: 10.1167/iovs.14-16338.
2. Yu Y, An M, Mo B, et al. Risk factors for choroidal detachment following rhegmatogenous retinal detachment in a chinese population [J]. BMC Ophthalmol, 2016, 16: 140. DOI: 10.1186/s12886-016-0319-9.
3. Shen L, Mao J, Sun S, et al. Perioperative pharmacological management of choroidal detachment associated with rhegmatogenous retinal detachment[J]. Acta Ophthalmol, 2016, 94(4): 391-396. DOI: 10.1111/aos.12694.
4. Wei Y, Wang N, Chen F, et al. Vitrectomy combined with periocular/intravitreal injection of steroids for rhegmatogenous retinal detachment associated with choroidal detachment[J]. Retina, 2014, 34(1): 136-141. DOI: 10.1097/IAE.0b013e3182923463.
5. 毛剑波, 吴素兰, 陈亦棋, 等.后Tenon囊下注射曲安奈德联合玻璃体切割术在脉络膜脱离型视网膜脱离中的应用[J]. 中华实验眼科杂志, 2017;35(5): 448-452. DOI: 10.3760/cma.j.issn.2095-0160.2017.05.013.Mao JB, Wu SL, Chen YQ, et al. Application of subtenon injection of triamcinolone acetonide combined with vitrectomy in the treatment of retinal detachment with choroidal detachment[J]. Chin J Exp Ophthalmol, 2017, 35(5): 448-452. DOI: 10.3760/cma.j.issn.2095-0160.2017.05.013.
6. The Retina Society Terminology Committee. The classification of retinal detachment with proliferative vitreoretinopathy[J]. Ophthalmology, 1983, 90(2): 121-125.
7. 刘文, 张少波, 柯治生, 等.微创玻璃体切割手术治疗脉络膜脱离型视网膜脱离临床疗效观察[J]. 中华眼底病杂志, 2012, 28(6): 593-597. DOI: 10.3760/cma.j. issn.1005-1015.2012.06.012.Liu W, Zhang SB, Ke ZS, et al. The efficacy of micro-invasive vitrectomy for retinal detachment associated with choroidai detachment[J]. Chin J Ocul Fundus Dis, 2012, 28(6): 593-597. DOI: 10.3760/cma.j.issn.1005-1015.2012.06.012.
8. Gu YH, Ke GJ, Wang L, et al. Risk factors of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese patients[J]. Int J Ophthalmol, 2016, 9(7): 989-993. DOI: 10.18240/ijo.2016.07.09.
9. Li Z, Li Y, Huang X, et al. Quantitative analysis of rhegmatogenous retinal detachment associated with choroidal detachment in Chinese using UBM[J]. Retina, 2012, 32(10): 2020-2025. DOI: 10.1097/IAE.0b013e3182561f7c.
10. 张忠红, 赵培泉, 张琦.前房灌注玻璃体视网膜手术治疗脉络膜脱离型视网膜脱离一例[J]. 中华眼底病杂志, 2012, 28(4): 422. DOI: 10.3760/cma.j.issn.1005-1015.2012.04.032.Zhang ZH, Zhao PQ, Zhang Q. One case of vitrectomy combined anterior chamber infusion for rhegmatogenous retinal detachment associated with choroidal detachment[J]. Chin J Ocul Fundus Dis, 2012, 28(4): 422. DOI: 10.3760/cma.j.issn.1005-1015.2012.04.032.
11. 郭嘉术, 王海林, 赵秀军. 新型25-Gauge与传统20-Gauge玻璃体切除术后干眼对比[J]. 国际眼科杂志, 2009, 9(6): 1106-1108. DOI: 10.3969/j.issn.1672-5123.2009.06.031.Guo JS, Wang HL, Zhao XJ. Differences of postoperatie dry eyes between 20-gauge and 25-gauge vitrectomy[J]. Int J Ophthalmol, 2009, 9(6): 1106-1108. DOI: 10.3969/j.issn.1672-5123.2009.06.031.
12. Kwon OW, Song JH, Roh MI. Retinal detachment and proliferative vitreoretinopathy [J]. Dev Ophthalmol, 2016, 55: 154-162. DOI: 10.1159/000438972.
13. Adelman RA, Parnes AJ, Michalewska Z, et al. Clinical variables associated with failure of retinal detachment repair: the European vitreo-retinal society retinal detachment study report number 4 [J]. Ophthalmology, 2014, 121(9): 1715-1719. DOI: 10.1016/j.ophtha.2014.03.012.
14. Gui JM, Jia L, Liu L, et al. Vitrectomy, lensectomy and silicone oil tamponade in the management of retinal detachment associated with choroidal detachment[J]. Int J Ophthalmol, 2013, 18;6(3): 337-341. DOI: 10.3980/j.issn.2222-3959.2013.03.15.
15. Vaziri K, Schwartz SG, Kishor KS, et al. Tamponade in the surgical management of retinal detachment [J]. Clin Ophthalmol, 2016;10: 471-476. DOI: 10.2147/OPTH.S98529.