【摘要】目的：观察分析巩膜扣带术不放液治疗陈旧性视网膜脱离的临床效果。方法：回顾分析我科46例(46眼)陈旧性视网膜脱离患者经巩膜扣带术不放液进行治疗。病例资料,男39例,女7例。年龄9~18岁15例，18~35岁20例，35岁以上11例。提供病史2mo~2a。视网膜下方2个象限浅脱离35眼占76%，其视网膜小圆孔、多筛孔36眼占78%，所有患者脱离的视网膜下均伴有黄色机化条索，46眼均行外路手术不放视网膜下液，采用单纯巩膜外加压16眼(35%),环扎联合加压30眼 (65%)。结果：随访1~12mo，46眼中有44眼1次手术达到视网膜解剖复位（96％），术后矫正视力0.1以上36眼。结论：巩膜扣带术不放液治疗好发于青少年陈旧性视网膜脱离，简单有效。
【关键词】 巩膜扣带术；陈旧性视网膜脱离；治疗
Clinical effects of scleral buckling without subretinal drainage on treatment of longstanding primary retinal detachment
Yun Xiao, YinBo Fan, XiaoWei Gao, XueHong Cai, ZhengHua Xu, Yong Zhao
Department of Ophthalmology, No. 474 Hospital, Ophthalmic Center of Chinese PLA, Urumchi 830011, Xinjiang Uigur Autonomous Region, China
Correspondence to: Yun Xiao. Department of Ophthalmology, No. 474 Hospital, Ophthalmic Center of Chinese PLA, Urumchi 830011, Xinjiang Uigur Autonomous Region, China. [email protected]
AbstractAIM: To observe and analyze the clinical effects of scleral buckling without subretinal drainage on treatment of longstanding primary retinal detachment.
METHODS: Fortysix cases (46 eyes) with longstanding primary retinal detachment treated by scleral buckling without subretinal drainage in our department were retrospectively analyzed. Of them, 39 cases were male and 7 cases were female. Fifteen cases were aged from 9 to 18 years old, 20 cases was in 1830 years old, and 11 cases were more than 35 years old. The duration of the disease ranged from 2 months to 2 years. The bottom two quadrant shallow retinal detachment was in 35 eyes (76%), the retinal small round hole or sievemesh appeared in 36 eyes (78%). All cases had subretinal yellowwhite organization cord, in which, 46 eyes underwent surgical operation without subretinal drainage, 16 eyes (35%) were adorpted simple scleral buckling and cerclage combined buckling was performed on 30 eyes (65%).RESULTS: After 112 months of followup,44 eyes(96%) of 46 eyes obtained anatomic reattachment, postoperative corrected visual acuities were achieved 0.5 or better in 36 eyes.CONCLUSION: Scleral buckling without subretinal drainage is an effective and simple surgical method for treatment of longstanding retinal detachment in juvenile.
KEYWORDS: scleral buckling; surgery; longstanding retinal detachment
0引言
视网膜脱离是眼科重要致盲性疾病，临床诊断和治疗比较困难。20世纪60年代以后，间接检眼镜、冷凝技术和低反应的巩膜植入物的应用，使视网膜脱离的诊断水平和手术成功率大大提高[1]。早期发现及时手术治疗是减少致盲率的关键。而好发于青少年的陈旧性原发性视网膜脱离的患者大多数是偶尔发现视力不佳就诊,病程时间较长而影响治疗效果。为进一步认知该病的临床特征、治疗方法及疗效,我院对46例(46眼)陈旧性视网膜脱离患者进行了回顾性分析,现将结果报告如下。
1对象和方法
1.1对象
200502/200701在我院手术治疗的陈旧性原发性视网膜脱离46例(46眼)，男39例(39眼)，女7例(7眼)，年龄9~50（平均23.5）岁，35岁以下35眼占76%，就诊时视力:手动~0.05者41眼,0.05~0.2者5眼。视力下降至就诊时间2~3mo者16眼,3~6mo者12眼,6~12mo者7眼,12~24mo者11眼。手术前屈光状态:5眼> 6.00DS,15眼3.00~ 6.00DS,20眼<3.00DS,6眼正视眼。视网膜脱离范围及形态:下方2个象限浅脱离波及到黄斑区35眼, 3个象限浅脱离4眼，7眼全视网膜脱离；3眼视网膜囊肿形成（黄斑囊肿1眼）。视网膜脱离均隆起的不高,脱离的视网膜波动度不大，其视网膜下有黄色沉着物及条索,似分界线，数量多条不等，有的在视网膜裂孔周围，有的在黄斑周围或横跨多个象限。视网膜裂孔:4∶00~6∶00，6∶00~8∶00位于周边部的小圆孔或多个筛孔（36眼）占78%,下方锯齿缘截离5眼,占11%,未找到裂孔眼，占11%,按1983年美国视网膜协会增生性玻璃体视网膜病变分级应为PVR BC2级。
1.2方法
根据视网膜脱离范围及裂孔的分布、视网膜下条索位置及数量选择手术方式：46眼均采用直视下冷凝封闭裂孔，手术中前房穿刺软化眼球，裂孔封闭采用硅海绵或者硅胶海绵复合体充分垫压,5眼未找到明显裂孔者冷凝变性区可疑。30眼行巩膜环扎外加压术,16眼行单纯外加压术，46眼均未放视网膜下液体，未进行玻璃体内注入消毒空气。
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