作者：付群 张光军，徐 雯 作者单位：1.新乡医学院第三附属医院眼科，河南 新乡 453003；2.新乡医学院药物研究室
【摘要】 目的：探讨干性视网膜裂孔眼底光凝治疗术对患者视力预后的影响。方法：回顾分析2000年1月至2007年12月在我院眼科接受眼底光凝治疗的干性视网膜裂孔病例，并且随访时间≥6月、随访资料完整者177例（179眼），按照随访时间，专人负责观察视力﹑眼压﹑间接检眼镜眼底检查；术后2周、4周、2月、6月、12月随访，最长随访至术后5年。采用SPSS 14.0进行统计学处理。率的检验用x2检验，均值比较采用t检验。结果：本组病例术后复诊时眼底检查均可见视网膜裂孔封闭良好，孔周可见视网膜萎缩斑和明显色素沉着，治疗部位未发现新的视网膜脱离。治疗前和治疗后6月时视力/矫正视力分别为0.63±0.29和0.67±0.31，无显著差异（t=0.04,P>0.05)，视力水平构成比也无显著差异（x2=2.47,P>0.05）。结论：干性视网膜裂孔行眼底激光光凝术安全可靠、无不良反应，尤其在视网膜脱离高危人群包括高度近视眼、无晶状体眼和人工晶状体眼、钝挫伤以及另眼有视网膜脱离病史者 ，更应常规散瞳进行详细的眼底检查，早期发现干性裂孔，及时给予眼底激光光凝术，防患于未然。
【关键词】 光凝术；激光；随访；干性视网膜裂孔
A follow-up study of laser photocoagulation on dry retinal tear
FU Qun1, ZHANG Guang-jun2, Xu Wen1
(1.Department of Ophthalmology, the 3rd affiliated hospital of Xinxiang medical university, Henan 453000, China；
2.Division of drug research, Xinxiang medical university)
【Abstract】 Objective：To investigate the clinical effects of laser photocoagulation on dry retinal tear. Methods:A retrospective analysis on the cases of dry retinal tear occurred between from January 2000 to December 2007 were treated by the laser photocoagulation. These cases were followed-up for more than months, and collected a completed case information from 177 individuals for 179 eyes. During the follow-up period, these cases were examined by ophthalmological specialists and treated on visual acuity, intraocular pressure and ocular fundus with indirect ophthalmoscope. Analysis of the data was carried out with the Statistical Package for Social Sciences (SPSS 14.0, Chicago, IL, USA). Statistically significant differences were determined using paired Student's t-test, Wilcoxon test for unpaired data or Fisher's exact test as appropriate. P-value of 0.05 was considered statistically significant.Results: The periods of postoperative follow-up were 2 weeks, 4 weeks, 2 months, 6 months, and 12 months, respectively. All cases of ocular fundus presented well-blockage of retinal tear, retina maculae atrophic and obvious pigmentation display around the tear. New retinal detachment was not found at the curative location. The visual acuity and corrected vision in the prior treatment and 6 months after post-treatment were 0.63±0.29 and 0.67±0.31. A paired t-test comparing the results were no found significant difference. There was no significant difference (t=0.04, P>0.05) and no statistical significantly difference were found for the component ratio of visual acuity (x2=2.47, P>0.05）.Conclusions: The technique using the laser photocoagulation on dry retinal tear appears to be safe and reliable, especially applied among the high-risk population with retinal detachment including the high myopia, the aphakia, ocular blunt trauma and the artificial-lens. Ectopic patients with another retinal detachment should be prevented if a routinely mydriasis and detailed examination of ocular fundus are applied. The dry tear could be discovered early and treated well if the laser photocoagulation is applied on time.
【Key words】Laser photocoagulation; Laser; Follow-up ; Dry retinal tear
视网膜裂孔（Retinal tear）是原发性视网膜脱离的主要原因，后者会严重影响视功能。单纯的不伴有视网膜脱离的裂孔又被称为干性视网膜裂孔（dry Retinal tear）。眼底激光光凝术在干性视网膜裂孔中的应用被认为是一种简便、安全、快捷的治疗方法［1］。为了解眼底激光光凝术治疗干性视网膜裂孔远期疗效和可能存在的不良反应，我们对接受眼底光凝治疗术治疗的干性视网膜裂孔177例进行了随访观察，现报告如下。
1 资料和方法
1.1 资料 2000年1月至2007年12月在我院眼科接受眼底光凝治疗术治疗的干性视网膜裂孔病例，并且随访时间≥6月、随访资料完整者177例（179眼）；其中男106例(108眼)，女71例(71眼)；年龄16～57岁，平均（40.6±14.2）岁。干性视网膜裂孔的诊断［2,3］：所有病例就诊时先进行常规视力和眼底检查；对中高度近视、眼球钝挫伤以及另眼有视网膜脱离病史并且眼前有闪光感者，充分散瞳后，表面麻醉，放置Goldman三面镜（美国Ocular公司）进行眼底检查确诊，并以视盘为中心将眼底分为鼻上、鼻下和颞上、颞下共4个象限，发现并详细记录视网膜裂孔的部位、形态。
1.2 激光眼底光凝方法 采用NIDEK GYC-1000眼底激光治疗装置，波长532 nm，光斑直径100～200 μm，输出功率100～350 mW，曝光时间0.1～0.2 s；光凝能量：以从小能量逐渐加大至Ⅲ级光斑反应为宜，两个光凝点之间间隔0.5个光斑距离；激光治疗前进行头部姿势训练，充分散瞳，表面麻醉，放置Goldman三面镜（美国Ocular公司）。选择视网膜裂孔部位位于黄斑中心凹200 μm以外应用直接光凝法：沿着裂孔边缘进行双排光凝，内外圈光斑交错；如果并发孔周视网膜浅脱离，则沿着网脱和正常视网膜交界处进行3～4圈堤坝式光凝，以后复诊，待视网膜下积液吸收后，再逐渐光凝至视网膜裂孔缘。
1.3 疗效标准［4］ ①痊愈：光凝过程中可见III级光斑反应，术后视网膜裂孔边缘出现“堤坝样”光凝斑和色素沉着,裂孔闭合或变小、变形，孔周视网膜下积液吸收，视网膜平复,玻璃体混浊减轻或消失，视力不变或略有提高。②未愈：光凝过程中未见光斑反应或光斑反应弱，视网膜裂孔未闭，术后未见光凝斑和色素沉着，视网膜下积液增加，视网膜脱离范围扩大，需再施行视网膜脱离复位手术。
1.4 随访观察项目 所有疑似干性视网膜裂孔病例在初次就诊时详细记录通讯方式、联系人，在临床确诊和治疗后列入随访观察病例，详细告知复诊时间，并专人定时电话预约复诊。随访观察项目包括视力和间接检眼镜眼底检查。
1.5 数据处理 采用SPSS 14.0进行统计学处理，率的检验采用x2检验，均值的比较采用t检验。
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