| 【摘要】 目的 探讨硅油填充眼复发性视网膜脱离手术治疗的方法和效果，以便提高手术成功率。方法：收集硅油填充眼复发性视网膜脱离后行手术治疗的病例20例（20眼），视网膜脱离的形态符合孔源性视网膜脱离或牵拉性视网膜脱离的特征，其中包括硅油填充下增生性玻璃体视网膜病变（PVR）。手术治疗方式包括：硅油取出、视网膜光凝、膜剥除、重水应用、视网膜切开/切除、气体/硅油充填和巩膜扣带术。观察术后及随访的视网膜复位率，术前与术后的视力和眼压变化。结果：硅油填充后发生视网膜脱离20眼均行玻璃体手术治疗，手术方式包括：硅油全部取出20眼，视网膜光凝19眼，膜剥除15眼，重水应用9眼，二次硅油填充9眼，长效气体填充10眼，环扎4眼。随访3～21个月，20眼术后早期（<1w）均视网膜复位（100％）；16眼视网膜复位保持至最后一次随访；4眼1周～1个月后发生视网膜下方的浅脱离，均行再次手术，其中长效气体填充1眼，随访3个月视网膜复位；再次硅油填充3眼，2眼6个月后再次取出硅油，术后随访视网膜复位；1眼术后下方视网膜再次浅脱离，因患者拒绝手术，未行再次手术。总视网膜复位率95.0％（19/20）。3眼（15％）术后眼压升高（>21 mmHg），药物可以控制在正常范围。14眼（70％）术后视力比术前有不同程度的提高。结论：硅油填充眼复发性视网膜脱离，采用全部取出硅油后玻璃体手术的方法可以获得很高的总视网膜复位率（95.0％），手术时间短，手术次数少，眼压稳定，能获得不同程度的视力提高。与国内外文献报道的单纯巩膜扣带术和其他玻璃体手术方法比较，术后早期及总视网膜复位率均有提高，但在统计学上无显著性差异。
[Abstract] Objective To investigate the feasibility of using vitrectomy to treat recurrent retinal detachment in silicone oil tamponade eye. Methods: 20 cases with recurrent retinal detachment, after vitrectomy and silicone oil tamponade surgery, were reviewed respectively. The surgical methods used in these cases includeing: removing silicone oil, photo-coagulation of retina tear, peeling of retina membrane, perfluorocarbon liquid (PFCL) to flat retina, retinectomy and/or retinotomy, gas/Silicone oil tamponade, with/without extra-sclera buckle and/or extra-sclera cerclage. The patients were followed up for 3-21 month. Ophthalmic examination included best-correct visual acuity, intraocular pressure, B-mode scan and fundus photography were performed. Results: Vitrectomy was performed in 20 eyes. The methods used in the vitectomy including: retina photo-coagulation in 19 eyes; membrane peeling in 15 eyes; PFCL in 9 eyes; silicone oil tamponade in 9 eyes; long acting gas in 10 eyes; ex-sclera cerclage in 4 eyes; silicone oil remove in all eyes during the operation. During the follow-up, all 20 eyes showed retina reattached in the first week after-op. 4 of 20 eyes showed retina detachment recurred after-op, of which 1 eye tamponaded with non expending gas and 3 eyes refilled with silicone oil that removed after 6 month in the further surgery and one eye was refused accept further surgery. The total success rate is 95% (19/20); intraocular pressure after the operation remain stabilize in all 20 eyes; visual acuity was improved in 14/20 (70%) eyes after these vitrectomy. Conclusion: The vitrectomy with silicone oil removal is an effective management for retinal detachment recurrence in silicone oil tamponade eye. This method has a higher retina reattached rate (95.0%) and has less operation times.
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