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Efficacy of Pneumatic Retinopexy in the Treatment of Primary Rhegmatogenous Retinal Detachment
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摘要:
目的 分析玻璃体注气术治疗单纯性孔源性视网膜脱离的效果及预后。 方法 收集2008年8月至2012年7月因单纯性孔源性视网膜脱离于本院眼科接受玻璃体注气术的患者资料, 共16例16眼, 均行表面麻醉下手术, 术后根据视网膜裂孔的位置指导患者选择合适的体位, 术后1~3 d进行视网膜激光光凝封闭视网膜裂孔。总结术后视网膜复位率、视力恢复情况及手术并发症。 结果 16例患者中, 男8例, 女8例, 年龄(46.4±14.4)岁(19~68岁), 病程(16.8±14.7)d(3~60 d), 术后随诊时间(7.3±7.0)个月(1~28个月)。15例视网膜裂孔位于上方8个钟点内, 1例裂孔位于颞下方。14例为圆形或马蹄形裂孔, 其中10例1个裂孔, 3例2个裂孔, 1例3个裂孔, 另2例有多发筛状裂孔, 但裂孔范围小于3个钟点。所有患者手术过程顺利, 2例术后出现眼压升高, 使用局部降眼压药物治疗后恢复正常。13例患者术后视网膜复位, 5例在术后4 d至4个月复发视网膜脱离, 其中3例为原视网膜裂孔未能闭合, 2例为新发裂孔。一次手术未成功的患者, 再次或者多次手术后视网膜总复位率为100%。一次手术成功的8例患者中, 5例末次随访视力在0.5或以上, 5例术后视力提高, 3例无变化; 两次或者多次手术的8例患者中, 3例末次随访视力在0.5或以上, 5例术后视力提高, 1例无变化, 2例下降。9例黄斑脱离的患者中, 7例术后视力提高, 而7例无黄斑脱离的患者中, 3例术后视力提高。 结论 对于孔源性视网膜脱离, 玻璃体注气术是一种操作简单的手术方法, 选择合适的病例可以达到较好的治疗效果, 但术后新发视网膜裂孔和复发视网膜脱离的发生率相对较高, 因此术前应掌握手术适应证, 术后应严密随访。 -
关键词:
- 玻璃体注气术 /
- 视网膜激光光凝 /
- 单纯性孔源性视网膜脱离
Abstract:Objective To analyze the efficacy and prognosis of pneumatic retinopexy for primary rhegmatogenous retinal detachment. Methods Totally 16 patients (16 eyes) diagnosed as primary rhegmatogenous retinal detachment and received pneumatic retinopexy in our hospital from August 2008 to July 2012 were enrolled in this study. All the patients received the procedure under topical anesthesia, positioned properly after operation, and underwent retinal photocoagulation 1 to 3 days after the operation. The retinal reattachment rate, visual acuity, and complications of the operation were summarized. Results There were 8 males and 8 females aging 19 to 68 years old (mean 46.4±14.4 years). Their disease course ranged from 3 to 60 days (mean 16.8±14.7 days), and the follow-up time was 1 to 28 months (mean 7.3±7.0 months). Retinal breaks were within the upper 8 clock-hour in 15 cases, and located at the subtemporal retina in 1 case. Fourteen cases had round or horseshoe shaped holes, with 1 hole in 10 cases, 2 holes in 3 cases, and 3 holes in 1 case. The other 2 cases had multiple cribriform holes, but limited in 3 clock-hour extent. Postoperative intraocular pressure rose in 2 cases, and returned to normal after using topical ocular hypotensive medications. Pneumatic retinopexy resulted in reattachment in 13 cases, but redetachment happened in 5 eyes after 4 days to 4 months, including 3 cases of unclosed holes and 2 cases of new retinal holes. Reoperations were carried out for 8 patients, and the final retinal reattachment rate was 100%. Among the 8 cases that succeeded after primary pneumatic retinopexy, visual acuity was improved in 5 cases and stable in 3 cases, with 5 cases attaining visual acuity of 0.5 or more. Among the 8 cases that received two or more operations, visual acuity was improved in 5 cases, stable in 1 case, and decreased in 2 cases, with 3 cases attaining visual acuity of 0.5 or more. Visual acuity improved in 77.8%(7/9) of macular-off cases and 42.9%(3/7) of macular-on cases. Conclusions Pneumatic retinopexy is a simple procedure for primary rhegmatogenous retinal detachment. It can achieve satisfied results in properly selected cases. However, the incidences of new retinal holes and redetachments can be high, so strict indications and close follow-up are particularly important for this procedure. -
图 1 47岁男性右眼单纯性孔源性视网膜脱离患者(病例10)术前及术后眼底彩照
A.术前，右眼鼻上方视网膜2个裂孔，10: 00~3: 00视网膜脱离；B.玻璃体注气术后1 d，视网膜完全复位，行视网膜激光光凝封闭裂孔；C.术后2.5个月，视网膜在位，可见裂孔周围陈旧性激光斑
表 1 16例单纯性孔源性视网膜脱离患者的术前资料
编号 性别 年龄(岁) 眼别 屈光度(D) 裂孔数量 裂孔位置和形状 视网膜脱离范围 黄斑脱离 视力 1 女 61 右眼 -3.00 1 颞上方圆孔 颞侧及颞下 是 0.01 2 女 41 右眼 - 多发 上方变性区内筛孔 3:00~10:00 否 1.0 3 男 57 右眼 -6.00 1 10:00马蹄孔 8:00~12:00 是 0.25 4 女 37 右眼 -7.00 1 上方圆孔 上方 是 手动 5 男 53 左眼 -6.00 2 颞上圆孔、马蹄孔 12:00~4:00 是 0.15 6 男 44 右眼 -9.00 1 上方马蹄孔 9:30~1:30 是 0.06 7 男 26 右眼 -2.00 3 颞下方圆孔 7:30~9:00 否 0.6 8 女 19 左眼 -3.50 1 1:00圆孔 颞上方 否 0.6 9 女 60 右眼 -2.00 1 10:00圆孔 9:00~1:00 否 0.15 10 男 47 右眼 -5.00 2 2:00圆孔、马蹄孔 10:00~3:00 否 0.6 11 女 68 右眼 - 1 颞上圆孔 颞上方 否 0.7 12 男 59 右眼 -8.00 多发 12:00筛孔 6:00~12:00 是 0.02 13 女 39 左眼 -7.25 2 颞上圆孔 颞上方 否 0.8 14 女 49 右眼 -4.00 1 11:00圆孔 6:00~11:00 是 0.8 15 男 25 左眼 -5.00 1 上方圆孔 上方 是 0.1 16 男 57 右眼 - 1 1:00马蹄孔 上半 是 0.4 -：无屈光不正 
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表 2 16例单纯孔性源性视网膜脱离患者的手术情况及术后资料
病例 注气成分 体积(ml) 初次手术
视网膜复位复发情况 再次手术 最终视网膜
复位随访时间
(月)最终视力 1 50% C3F8 1 否 PPV+激光+10% C3F8
PPV+激光+硅油
环扎+局部加压是 5 0.2 2 纯C3F8 0.8 否 PPV+激光+10%C3F8 是 6 0.5 3 纯C3F8 0.4 是 是 1 0.25 4 纯C3F8 0.6 是 2次新发裂孔、RD PPV+激光+10%C3F8
巩膜外环扎+放液+冷冻+局部
加压是 6 0.3 5 纯C3F8 0.8 是 复发RD
新发黄斑裂孔PPV+激光+14%C3F8
ILM剥离+10%C3F8是 17 0.05 6 50%C3F8 1 是 是 1 0.1 7 纯C3F8 0.5 是 是 1 0.6 8 纯C3F8 0.5 是 新发裂孔、RD 巩膜外加压+环扎 是 28 0.9 9 纯C3F8 1 是 是 8 0.15 10 纯C3F8 0.3 是 是 4 0.8 11 纯C3F8 0.6 是 是 3 0.8 12 纯C3F8 0.7 是 复发RD PPV+激光+10%C3F8 是 6 0.2 13 纯C3F8 0.5 是 是 5 0.8 14 纯C3F8 0.6 是 复发RD 巩膜外加压 是 7 0.8 15 纯C3F8 0.3 否 PPV+剥膜+激光+14%C3F8
冷冻+局部加压+注气是 14 0.12 16 纯C3F8 0.5 是 是 4 0.5 RD：视网膜脱离；PPV：玻璃体切除术；ILM：视网膜内界膜
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