【摘要】 目的探讨显微镜联合间接眼底镜下治疗视网膜脱离的临床疗效。方法对32例(32只眼)孔源性视网膜脱离患者在显微镜联合间接眼底镜下施行巩膜外冷凝、环扎、外垫压、放液、注气等视网膜脱离复位术,术前、术中详细检查眼底,寻找所有裂孔及变性区,予以封闭。结果术后随访1～12个月,32例患者中31例1次手术达到解剖复位,治愈率97.2%,术后患者最佳矫正视力均有不同程度提高。术中放液时引起视网膜下出血1例,视网膜表面出血3例,术后视网膜下液延缓吸收10例,均在术后1周内吸收;术后眼压升高8例,6例经药物治疗,2例经前房穿刺眼压降低;6例气体填充眼出现晶状体后囊下混浊,随气体吸收于2周内消失;术后玻璃体混浊加重15例,经药物治疗13例恢复至术前水平;1例由于增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)加重,引起新裂孔,行玻璃体切割术,术后视网膜复位良好。结论显微镜联合间接眼底镜下治疗视网膜脱离复位术具有操作简单、定位准确、视野清晰、手术时间短、复位率高、并发症少等优点,不失为一种值得推荐的手术方法。更多还原

【Abstract】 OBJECTIVE To observe the clinical effect of retinal detachment surgery with binocular indirect ophthalmoscope and ophthalmic microscope.METHODS Thirty-two cases diagnosed as rhegmatogenous retinal detachment were undertaken retinal detachment surgery under microscope combined with binocular indirect ophthalmoscope such as scleral cryopexy,scleral circling,scleral buckle operation,drainage of subretinal fluid and intravitreal injection of pure C3F8.Preoperative and intraoperative detailed eye fundus was checked looking for all the retinal holes and degeneration zones and then all was closed.RESULTS Thirty-two cases(32 eyes) were followed up for 1~12 months after operation and 31 got complete retinal reattachment.Cure rate was 97.2%.Postoperative best corrected visual acuity improved at different levels.Subretinal hemorrhage occurred in 1 case,retinal hemorrhage occurred in 3 eyes,10 cases of subretinal fluid causing delayed absorption,all patients absorbed within 1 week.Postoperative intraocular pressure raised in 8 cases,of which 6 patients backed to normal with medication.The intraocular pressure reduced in 2 cases by anterior chamber paracentesis.Six gas-filled eyes appeared posterior capsular opacity.When the gas absorbed,posterior capsular opacity disappeared in 2 weeks.Fifteen cases of vitreous opacity increased,of which 13 eyes returned to preoperative levels after drug treatment.Another case which increased PVR caused a new hole,but the reduction of retinal was good after vitrectomy.CONCLUSIONS Retinal detachment surgery under microscope combined with binocular indirect ophthalmoscope bore the advantages of easy operation,accurate positioning,clear vision,short time,high reduction rates,fewer complications and could yet be regarded as a recommended method of operation.更多还原