巨大裂孔性视网膜脱离的现代治疗
胡土荣
【摘要】目的 为了进一步探讨现代玻璃体视网膜手术对各种巨大裂孔（Giant retinal breaks, GRB）性视网膜脱离治疗的疗效，以及如何提高其疗效。方法 回顾性分析巨孔性视网膜脱离71眼；其中巨大视网膜撕裂孔（Giant retinal tear, GRT ）36眼，巨大锯齿缘截离(Giant dialysis GD )14眼，巨大视网膜切开孔(Giant retinotomy GRO )21眼。采用全玻璃体切除，剥膜，松解性视网膜切开，应用氟碳液，光凝孔，有19眼作周边3600光凝。45眼注入硅油，26眼注入C3F8气体填充；6眼巩膜外加压及环扎。结果 出院时68眼视网膜解剖复位，占95.8%；57眼随访6~36月，视网膜解剖复位42眼，占73.7%，最后复位率 93%。GRT组 随访30 例，视网膜复位24眼，占80%；最终治愈率93.3%。GRO组随访18例，复位11眼，占61%，最终治愈率为88.9%；GD组随访9眼，视网膜复位7眼，占77.8%，最终治愈率为100%。术后主要并发症，黄斑前膜4眼，视网膜前膜5眼，视网膜裂孔3眼。结论 用现代方法对三组巨大裂孔性视网膜脱离治疗的疗效经统计学方法处理差异无显著性意义； 术后失败主要原因为下方PVR发展和巨孔一端或下端裂孔再开放。为了提高 疗效，建议术中行全玻璃体切除，包括基底部玻璃体切除，剥净视网膜前、后增殖膜；对下方〈1500巨大裂孔，术前aPVR明显或术中增殖膜未取干净者，同时行巩膜环扎术；应用周边3600光凝，可避免术后继发视网膜再撕裂。
Modern treatment for giant breaks retinal detachment
Hu tu rong
Department of Ophthalmology , Eye and ENT Hospital , Shanghai Fudan University ,Shanghai 200031 , China.
[ Abstract] Objective To explore the therapeutic effects of micro-vitreoretinal surgery (MVRs) for giant breaks retinal detachment , as well as the way to improve its curative effect. Method A retrospective survey was done in71 patinets (71 eyes) with giant breaks retinal detachment who underwent complete vitrectomy combined with relaxing retinotomy and intraocular tamponade . Among them, 36 eyes were diagnosed giant retinal tear (GRT), 14 eyes were giant dialysis (GD) and 21 were giant retinotomy(GRO). 45 eyes were poured into silicone oil. 26 eyes were emptied into C3F8 . 19 eyes were applied 3600 peripheral retinal photocoagulation. 6 eyes were placed an encircling buckle. Results The retinae were completely reattached in 68 eyes(95.8%). Among the 57 eyes followed up for 6 ~36 months, 42 eyes (73.7%) remained retinal reattachment and 53 eyes (93% )remained retinal reattachment at last. Among the 30 GRT eyes, Followed –up found the 24 eyes with retinal attachment(80%) ；lastly cured(93.3%). Among the GRO eyes, 11 eyes remained retinal attachment(61%); last cured(88.9%).Among GD 9eyes, the retinal reattachment happen to 7 eyes(77.8%) with 100% cure rate. Post-operational complication includes macular epiretinal membrane 4 eyes ; epiretinal membrane 5eyes .and retinal tears 3 eyes. No statistical difference was found among 3 groups of GRT, GRO and GD (p>0.05). Conclusions The failure after operation was mainly due to an inferior quadrant proliferative processes and secondary reopening of the inferior end of the GRT . To improve the therapeutic efficacy, the complete vitrectomy was recommended including remove the vitreous base excision epiretinal membrane . In the case of〈1500 of inferior GRT，anterior PVR before operation , simultaneously using an encircling buckle . The 3600 peripheral retinal photocoagulation appears to be an effective way to reduce the risk of secondary tearing of the retina after the operation.
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