| 摘要
目的 研究玻璃体切割联合巩膜扣带、眼内填充硅油或惰性气体(C2F6)对晚期急性视网膜坏死所致的裂孔源性视网膜脱离的疗效。
方法 回顾性分析我院2003年4月至2005年12月收治的晚期急性视网膜坏死病人10例10只眼，此10例病人均经抗病毒药物联合糖皮质激素及抗凝药物治疗，但是玻璃体混浊持续进展眼底不能窥见，晚期发生视网膜脱离。其中男6例，女4例，年龄21~56岁，平均36.4±3.21岁，手术距发病时间1个月到半年，平均2.18±0.47个月，随访时间2~32个月，平均15.2±3.43个月。10只眼均经玻璃体切割加巩膜外垫压、环扎术，7只眼切除晶状体，4只眼行360度视网膜切开，9只眼硅油填充，1只眼C2F6填充。
结果 至随访结束时，10只眼中8只眼视网膜复位，1只眼部分复位，1只眼视网膜脱离复发。9只硅油填充眼中6只行硅油取出，其中5只眼视网膜复位，1眼视网膜脱离再发。视力情况：1只眼无变化,8只眼提高，1只眼减退。2只眼术后低眼压。
结论 晚期ARN所致的视网膜脱离，通过玻璃体切割手术联合硅油或惰性气体填充使视网膜复位，获得较满意的视力，若根据其临床特点早期诊断、早期用药、早期手术将会取得更好的预后。为预防低眼压发生，建议在行大面积视网膜切开切除的病人中，若无并发症的发生，硅油可暂不取出，以保存有用的视力。
The Curative Effect Of Vitrectomy For Later Stage Acute Retinal Necrosis
ZHAO Bing-shui CHU Yan-hua HAN Quan-hong LIU Bei LIN Si-yong
Department of Vitreous & Retina, TianJin Eye Hospital, 4# Gansu Road, Heping district, Tianjin, P.R. China. 300020
Abstract
Aim To investigate the curative effects of vitrectomy combined with scleral bucking and intraocular silicone oil or perfluoroethane （C2F6） tamponade for later stage acute retinal necrosis(ARN)
Methods Retrospectively analysis 10 eyes of 10 ARN patients in our hospital from 2003-4 to 2005-12 , who all have been treated by antivirus drug and cortisone, but during the therapy the vitreous opacity still progressed and the fundus could not be obsverved clearly , at the later stage the retinal detachment occurred. Of all the patients there are 6 male and 4 female, the age ranged from 21 to 56 years and averaged 36.4±3.21 years. The operations have been performed at 1 month to half a year after the disease has occurred, and averged 2.18±0.47 months. The following time was 2 to 32 months, averaged 15.2±3.43 months. All the 10 eyes have been performed vitrectomy combined with scleral buckling and circling, 7 of the 10 eyes have been extracted the lens, 4 of them have been conducted retina dissection of 360 degree, 9 of them were tamponaded with silicon oil and 1 eye was tamponaded with C2F6.
Results At the end of our following up, the retina have been well reattached in 8 patients, partly reattached in 1 eye, and detachment recurrence occurred in 1 eye. Of all the 9 eyes tamponaded with silicone oil , 6 eyes have been performed silicone oil removal, and the retina was well attached in 5 eyes. The vision: one eye has kept the same vision , 8 eyes have improved vision and only one eye decreased to hand movement before the eye. Hypotony has happened in 2 eyes.
Conclusions The retinal detachment caused by later stage ARN could be well reattached by vitrectomy, and the vision could be improved at the same time. To prevent hypotony, it has been suggested that if the patient has been performed retina dissection or excision in large area the silicone oil could not be removed until the complication has occurred. The prognosis could be improved by the early diagnosis and treatment of the disease. So perhaps the vitrectomy should be performed at the early stage.
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