微创医学

目的评价重硅油眼内填充治疗视网膜脱离的手术疗效及并发症。方法选择2008年1月至2009年12月我院收治的下方裂孔或后极部裂孔视网膜脱离,且因为年龄或全身因素无法俯卧位的患者20例(20眼),采用标准的睫状体扁平部三切口行玻璃体切除术,剥除视网膜前膜,重水压平视网膜,必要时行下方视网膜周边切开,气液交换后眼内激光封闭裂孔和视网膜切开边缘,玻璃体腔填充重硅油。结果随访4～21个月,平均7.3月,4例(占20%)患者于术后20d至4个月行硅油取出,2例由于重硅油乳化,1例由于药物控制不佳的继发性青光眼,1例网膜平复,16例仍未取出重硅油。并发症有:并发性白内障2例,重硅油乳化2例,高眼压3例,严重的前房炎症反应1例。结论对下方裂孔或后极部裂孔视网膜脱离的患者,行玻璃体切割联合玻璃体腔重硅油填充术,可获得满意的视网膜复位率,并发症发生率较低,可提高因为年龄或全身因素无法俯卧位患者的舒适性。

Objective To assess the efficacy and the incidence of complications of a heavy silicon oil as temporary internal tamponade in retinal detachment.Methods We chose twenty eyes of twenty unable lying prostrate patients with retinal detachment with inferior or posterior breaks between Jan 2008 and Dec 2009.The surgery method included vitrectomy through three incision in pars plana,subretinal neovascular membrane removal,deuterium oxide,tapping,gas liquid exchanger,intraocular photocoagulation and heavy silicone oil(Oxane HD) injection.Results All patients were followed up for 4-21 months with an average of 7.3 months.Of all cases,4 cases have accepted heavy silicone oil removal in 20 days to 4 months after retinal detachment surgery,2 cases due to silicon oil emulsification,1 case due to secondary glaucoma and 1 case due to reattached retina.There were still 16 cases with heavy silicone oil non-removed.In all patients,there were 2 case of complicated cataract,2 case of silicon oil emulsification,3 cases of temporary high intraocular pressure,and 1 case of excessive postoperative inflammation in anterior chamber.Conclusion Treating retinal detachment with inferior or posterior breaks with vitrectomy combined with intravitreal heavy silicone oil tamponade could secure a satisfactory rate of retinal reattachment,whereas the incidence of complications is low and the comfortability of old or unable lying prostrate cases is improving.