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目的总结玻璃体手术治疗的渗出性视网膜脱离患者的病因、手术指征及术后效果。设计回顾性病例系列。研究对象57例经玻璃体手术治疗的渗出性视网膜脱离患者。方法回顾性分析相应的临床资料。主要指标病因、手术指征及术后效果。结果57例(62眼)渗出性视网膜脱离中Coats病23例(45.2%),为引起渗出性视网膜脱离的主要病因;其次为家族性渗出性玻璃体视网膜病变8例(12.9%)、葡萄膜炎7例(11.3%)、视网膜血管瘤7例(11.3%)、泡性视网膜脱离6例(9.7%)、眼内炎4例(6.5%)和视乳头小凹2例(3.2%)。严重的渗出性视网膜脱离及并发增生性病变是进行玻璃体手术的指征。术后短期大部分患者可获有用视力;随访6个月以上者64.9%,渗出性视网膜脱离复发率为5.4%,大部分患者仍能保留有用的视力。结论Coats病是引起渗出性视网膜脱离中需要采取玻璃体手术治疗的最主要原因。当渗出性视网膜脱离引起增生性病变、玻璃体积血或病变累及黄斑时是采取玻璃体手术的主要指征。手术可使大部分患者获得有用视力。(眼科,2008,17:52-55)
Objective To summarize the etiology, surgical indications and postoperative effects of vitreous surgery for exudative retinal detachment. Design retrospective case series. Fifty-seven patients with exudative retinal detachment underwent vitrectomy. Methods Retrospective analysis of the corresponding clinical data. The main indicators of etiology, surgical indications and postoperative effects. Results Of the 57 cases (62 eyes), 23 (45.2%) had Coats’ disease in exudative retinal detachment, which was the main cause of exudative retinal detachment. The second was familial exudative vitreoretinopathy (12.9%), Seven cases (11.3%) of uveitis, seven cases (11.3%) of retinal hemangiomas, six cases (9.7%) of vesical retinal detachment, four cases of endophthalmitis (6.5%) and two cases (3.2% ). Serious exudative retinal detachment and concurrent proliferative lesions are indications for vitreous surgery. Most patients with short-term postoperative useful visual acuity; 64.9% were followed up for more than 6 months, exudative retinal detachment recurrence rate was 5.4%, most patients still retain useful vision. Conclusion Coats disease is the most important cause of vitreous surgery requiring exudative retinal detachment. When exudative retinal detachment causes proliferative lesions, vitreous hemorrhage or lesions involving the macula are the primary indications for vitreous surgery. Surgery can make most patients have useful vision. (Ophthalmology, 2008, 17: 52-55)