中华眼底病杂志

中华眼底病杂志

经结膜切口改良最小量巩膜外扣带手术治疗孔源性视网膜脱离的疗效观察

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目的 观察经结膜切口改良最小量巩膜外扣带手术治疗单纯孔源性视网膜脱离(RRD)的疗效。 方法 回顾性病例系列研究。临床检查确诊并行经结膜切口改良最小量巩膜外扣带手术的连续单纯RRD患者76例78只眼纳入研究。其中,男性41例42只眼,女性35例36只眼。平均年龄(33.90±15.60)岁。均行最佳矫正视力(BCVA)、三面镜、B型超声、超声生物显微镜、光相干断层扫描检查。采用标准对数视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。患眼logMAR BCVA为0.88±0.88。均行经结膜切口改良最小量巩膜外扣带手术。经结膜定位裂孔后,在裂孔相应位置做5~6 mm的放射状结膜切口;冷冻后,小儿开睑器撑开结膜切口,1~2 针固定小的硅海绵或硅胶。观察手术后1周,1、3、6个月患眼BCVA、眼压、泪膜稳定性、结膜外观恢复及视网膜复位情况。 结果 手术后1周,78只眼中,视网膜复位77只眼,占98.7%;改行玻璃体切割手术后视网膜复位1只眼,占1.3%。患眼logMAR BCVA为0.44±0.41;与手术前比较,差异有统计学意义(t=3.092,P<0.01)。手术中发生结膜切口撕裂1只眼。穿刺放液时发生视网膜下出血5只眼。其中,手术后3、6个月时视网膜下出血吸收分别为2、3只眼。手术后1周有视网膜下积液10只眼;6个月时完全吸收。手术后1周时,泪膜稳定性恢复至手术前水平;1个月时,结膜切口愈合。未发现巩膜穿孔、植入物排斥、复视或感染等其他手术并发症。 结论 在不影响视网膜复位率的前提下,经结膜切口行改良最小量巩膜外扣带手术减小损伤,可有效治疗单纯RRD;最大限度地保留结膜完整性,泪膜稳定性恢复快。

Objective To observe the surgical outcome of the modified transconjunctival technique for minimal segmental buckling on rhegmatogenous retinal detachment (RRD). Methods This is a retrospective case series. Seventy-six patients (78 eyes) with uncomplicated RRD who underwent the modified transconjunctival technique for minimal segmental buckling were enrolled in this study. There were 41 male (42 eyes) and 35 female (36 eyes). The average age was (33.9±15.6) years. Best corrected vision acuity (BCVA), fundus examination with three-mirrors lens, ocular B ultrasound, optical coherence tomography (OCT) were performed in all patients. BCVA was examined through Standard logarithmic visual acuity chart and transferred to logMAR vision for statistical analysis. The logMAR BCVA was 0.88±0.88. The technique was successfully performed in all 78 eyes. After transconjunctival location of the retinal break was made, a 5 to 6 mm radial conjunctival incision was performed corresponding to the retinal break without cutting the limbal conjunctiva–Tenon’s capsule. After cryopexy, a minimal explant was fixed with one to two sutures through the conjunctival opening, expanded by a pediatric speculum. BCVA, intraocular pressure, tear film stability, conjunctival recovery and retinal reattachment were collected 1 week, 1 month, 3 months, 6 months after surgery. Results One week after surgery, retinal reattachments were achieved in 77 of 78 (98.7%) eyes and 1 eye (1.3%) received vitrectomy. Compared before surgery, the logMAR BCVA improved to 0.44±0.41, with significant difference (t=3.092, P<0.01). Conjunctival incision tear occurred in 1 eye. Subretinal hemorrhage occurred in 5 eyes during subretinal fluid drainage procedure. Subretinal hemorrhage occurred in 5 eyes during subretinal fluid drainage procedure. Hemorrhage was absorbed in 2 of the 5 eyes at 3 months after surgery and absorbed in all 5 eyes at 6 months after surgery. Subretinal fluid occurred in 10 eyes at 1 week after surgery and be absorbed completely at 6 months after surgery. Tear film stability improved to preoperative lever at 1 week after surgery. Less change in corneal and conjunctival sensitivity was observed in all eyes. No other surgical complications were observed within the follow-up period, such as scleral perforation, explant extrusion, diplopia or infection. Conclusions The modified transconjunctival technique for minimal segmental buckling minimizes the damage to conjunctiva without reducing the retinal reattachment rate. It can effectively treat uncomplicated RRD with preserving an intact limbal conjunctiva and rapid tear film stability recovery.

关键词: 巩膜扣带术/方法; 视网膜脱离/外科学

Key words: segmental buckling/technique; retinal detachment/surgery

引用本文: 陈春丽, 金海鹰, 田恬, 朱修宇, 彭婕, 赵培泉. 经结膜切口改良最小量巩膜外扣带手术治疗孔源性视网膜脱离的疗效观察. 中华眼底病杂志, 2018, 34(2): 120-123. doi: 10.3760/cma.j.issn.1005-1015.2018.02.004 复制

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