23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离

Efficacy of 23G intra-infusion-assisted scleral buckling on spherical retinal detachment

摘要:

目的：观察23G后节灌注辅助下的巩膜扣带术治疗球形视网膜脱离的疗效，探讨其可行性。

方法：选取我院2017-02/2018-02被确诊为孔源性视网膜脱离且视网膜下液较多、呈球形脱离外观的患者21例21眼，在行巩膜扣带术中引流视网膜下积液前于睫状体扁平部预置23G后节灌注，术中对裂孔未作凝固处理，术后裂孔周围行激光光凝治疗。术后随访观察3～10mo，观察视网膜复位和并发症情况。

结果：所有患者手术过程顺利，术中均引流出视网膜下液并未见脉络膜出血和视网膜嵌顿； 术后第1d视网膜完全复位者18眼； 术后2～3d残留视网膜下液吸收完毕者2眼，视网膜脱离未复位者1眼，经再次外加压块调位术后视网膜复位，术后视网膜脱离复发者1眼，经玻璃体手术后视网膜复位。术中有视网膜下出血者1眼，出血范围<1PD，3mo后吸收，未见眼压异常、眼前段缺血和其他严重并发症。

结论：在球形视网膜脱离的巩膜扣带术中引流视网膜下积液前预置灌注，可有效维持术中眼内压平稳，减少因引流视网膜下积液时眼压过快下降导致的爆发性脉络膜上腔出血和术后发生脉络膜脱离的可能性，同时术中视网膜基本趋于平伏，裂孔定位相对准确，可提高手术成功率。

Abstract:

AIM: To observe the treatment effect and discuss availability of spherical retinal detachment by 23G intra-infusion-assisted scleral buckling.

METHODS: Twenty-one eyes were randomly selected from in-patients with rhegmatogenous retinal detachment with much subretinal fluid and spherical appearance between February 2017 and February 2018, which were suitable for scleral buckling. The 23G intra-infusion was placed in the pars plana of ciliary body before the surgery. Retinal hole was not solidified during operation. Laser photocoagulation was performed around the retinal hole after surgery. Retinal reattachment state and the complications were evaluated by 3 to 10mo follow up.

RESULTS: All patients have undergone operations smoothly. Subretinal fluid was drainage, chroidal bleeding and retinal incarceration did not appear during the operation. Eighteen eyes achieved retinal reattachment on the first postoperative day; Subretinal fluid of two eyes was asorbed fully; One eyes achieved retinal reattachment after the adjustment by the external pressure block. One eyes with recurrence achieved retinal reattachment after vitreoretinal surgery. One eye developed complication with subretinal hemorrhage and the range of bleeding was less than 1PD, which was absorbed after 3mo. There were no eyes found abnormal intraocular pressure, anterior segment ischemia or other sever complications.

CONCLUSION: The 23G intra-infusion was pre-placed before relieving fluid in the scleral buckling of retinal detachment, which can effective keep intraocular pressure stably and reduce the possibilities of explosive suprachoroidal hemorrhage and postoperative choroidal amotio triggered by fast decrease of intraocular pressure. The retina is flat basically and the hole location is relatively accurate, which improve the success of the surgery.