超高度近視合并孔源性視網(wǎng)膜脫離手術(shù)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(wǎng)膜脫離手術(shù)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(wǎng)膜脫離(rhegmatogenous retinal detachment,RRD)的手術(shù)方式、手術(shù)效果、術(shù)后并發(fā)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(shù)，玻璃體切除(pars plana vitrectomy,PPV)聯(lián)合硅油填充術(shù)，或玻璃體腔注氣術(shù)，回顧分析術(shù)后6mo內(nèi)患者的BCVA、眼壓、視網(wǎng)膜復(fù)位情況、裂孔閉合程度及術(shù)后并發(fā)癥。

結(jié)果：患者術(shù)后6mo時行PPV聯(lián)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(shù)的患者視力提高8眼(73%)。統(tǒng)計學(xué)檢驗可見手術(shù)治療能明顯改善患者視力，尤其PPV聯(lián)合硅油填充，但單純行鞏膜外加壓術(shù)患者視力在本研究中經(jīng)統(tǒng)計學(xué)檢驗顯示無明顯意義。PPV聯(lián)合硅油填充的患者術(shù)后高眼壓及復(fù)視等術(shù)后并發(fā)癥較其他術(shù)式更多。

結(jié)論：超高度近視合并孔源性視網(wǎng)膜脫離的患者需要及時行手術(shù)治療，對術(shù)者臨床經(jīng)驗及手術(shù)要求極高，需要術(shù)者根據(jù)視網(wǎng)膜裂孔的大小、位置及視網(wǎng)膜脫離范圍選擇不同的術(shù)式，及時恰當(dāng)處理術(shù)后并發(fā)癥，以爭取患者術(shù)后裂孔最大程度的閉合、提高視網(wǎng)膜復(fù)位率及視功能，提高患者生活質(zhì)量。

超高度近視；孔源性視網(wǎng)膜脫離；鞏膜外加壓術(shù)；玻璃體切除術(shù)

引用：張小娟，曹楠玨，強薇，等.超高度近視合并孔源性視網(wǎng)膜脫離手術(shù)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(fā)病越來越普遍，發(fā)病年齡越來越小，成為人們現(xiàn)代社會生活嚴重的困擾。……