超高度近視合并孔源性視網膜脫離手術治療的臨床分析

張小娟，曹楠玨，強　薇，陳曉隆

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超高度近視合并孔源性視網膜脫離手術治療的臨床分析

張小娟，曹楠玨，強薇，陳曉隆

Department of Ophthalmology,Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China

?METHODS: A total of 47 cases(47 eyes) with the super high myopia patients combined with RRD who accepted scleral buckling of external pressure, vitrectomy combined silicone oil filling, or intravitreous gas injection were chosen in our hospital from Jan.1, 2011 to Jan.1, 2016. Best corrected visual acuity(BCVA), intraocular pressure, retinal reattached rate, closure rate of holes and the postoperative complications of patients in half year were analyzed.

?RESULTS: Half a year postoperation, BCVA of twenty-four cases underwent vitrectomy combined silicone oil filling were improving(71%), and eight cases with scleral buckling surgery were enhanced(73%). Statistical test showed the surgical treatment could significantly improve patients’ eyesight, especially PPV with silicone oil, but the BCVA of patients with scleral buckling of external pressure in this study had no obvious significance according to the rank sum test. Compare with other surgery, pars plana vitrectomy(PPV) combined silicone oil filling had more complications, such as high intraocular pressure and diplopia.

?CONCLUSION: The therapy of super high myopia patients with rhegmatogenous retinal detachment need many years’ clinical experience, surgical skill of clinician and according to the number, the shape and the site of the retinal holes and area of detached retina, they need to choose the right means of surgery, and timely deal with postoperative complications, in order to improve the patients’ postoperative retina, reset rate and visual function.

目的：回顧分析超高度近視合并孔源性視網膜脫離(rhegmatogenous retinal detachment,RRD)的手術方式、手術效果、術后并發癥及處理方法。

方法：選擇2011-01-01/2016-01-01于我院就診的超高度近視合并RRD的患者47例47眼，并于我院行鞏膜外加壓術，玻璃體切除(pars plana vitrectomy,PPV)聯合硅油填充術，或玻璃體腔注氣術，回顧分析術后6mo內患者的BCVA、眼壓、視網膜復位情況、裂孔閉合程度及術后并發癥。

結果：患者術后6mo時行PPV聯合硅油填充的患者視力提高者24眼(71%)；單純行鞏膜外加壓術的患者視力提高8眼(73%)。統計學檢驗可見手術治療能明顯改善患者視力，尤其PPV聯合硅油填充，但單純行鞏膜外加壓術患者視力在本研究中經統計學檢驗顯示無明顯意義。PPV聯合硅油填充的患者術后高眼壓及復視等術后并發癥較其他術式更多。

結論：超高度近視合并孔源性視網膜脫離的患者需要及時行手術治療，對術者臨床經驗及手術要求極高，需要術者根據視網膜裂孔的大小、位置及視網膜脫離范圍選擇不同的術式，及時恰當處理術后并發癥，以爭取患者術后裂孔最大程度的閉合、提高視網膜復位率及視功能，提高患者生活質量。

超高度近視；孔源性視網膜脫離；鞏膜外加壓術；玻璃體切除術

引用：張小娟，曹楠玨，強薇，等.超高度近視合并孔源性視網膜脫離手術治療的臨床分析.國際眼科雜志2016;16(11):2150-2153

0　引言

近年來近視患者發病越來越普遍，發病年齡越來越小，成為人們現代社會生活嚴重的困擾。……