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目的伴视网膜下增殖的陈旧性孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)手术仍是难题,文中回顾性分析巩膜扣带联合冷凝放液术治疗陈旧性RRD伴明显视网膜下增殖的临床治疗效果。方法陈旧性RRD患者15例,玻璃体视网膜病变B级(包括B级)以下病例15例(15只眼),男12例,女3例;年龄17~45岁。近视患者14只眼,所有患眼均有明显视网膜下增殖,术前视力:6例≤0.01,6例为0.02~0.08,3例≥0.1。所有患者视网膜脱离范围在1/2象限及以上,黄斑脱离,手术方法为传统的巩膜扣带联合冷凝放液术。结果术后1个月,患者视网膜复位14例,成功率为93.33%,其中男11例,女3例。多数复位患者的术后视力较术前明显提高(Z=-3.24,P<0.01);1例未复位患者放弃再手术。光学相干断层成像(optical coherence tomography,OCT)的随访结果显示,当常规眼底检查正常时,黄斑区视网膜仍未完全复位。结论巩膜扣带术治疗陈旧性RRD伴视网膜下增殖安全有效,黄斑区视网膜的完全复位可能需要更长的时间。
The purpose of this study is still to solve the problem of old rhegmatogenous retinal detachment (RRD) with subretinal proliferation. The clinical efficacy of scleral buckling combined with condensate draining in the treatment of obsolete RRD with subretinal proliferation was retrospectively analyzed . Methods Fifteen patients with obsolete RRD, 15 patients (15 eyes) with grade B (including grade B) vitreoretinopathy, 12 males and 3 females, aged 17-45 years. Fourteen eyes of patients with myopia, all eyes have significant subretinal proliferation, preoperative visual acuity: 6 cases ≤ 0.01, 6 cases of 0.02 to 0.08, 3 cases ≥ 0.1. All patients with retinal detachment range of 1/2 quadrant and above, macular detachment, surgical methods for the traditional scleral buckling combined with condensate draining surgery. Results One month after operation, the retina was reset in 14 cases with a success rate of 93.33%, including 11 males and 3 females. The majority of patients underwent postoperative visual acuity was significantly improved compared with preoperative (Z = -3.24, P <0.01); 1 case of patients without reset give up surgery. Follow-up results of optical coherence tomography (OCT) showed that the macula retina still did not completely resemble when the normal fundus examination was normal. Conclusions Scleral buckling is safe and effective for the treatment of obsolete RRD with subretinal proliferation. It may take longer for the macular retina to fully resect.