目的：观察微创玻璃体切除联合空气填充治疗玻璃体视网膜手术后上方裂孔源性视网膜脱离的有效性及安全性。

方法：回顾分析2017-11/2019-10在我院收治的，经历过一次或多次玻璃体视网膜手术后发生的由上方裂孔(3：00～9：00水平线以上)引起且未合并严重增殖性玻璃体视网膜病变(PVR)的(PVR-C级以下)孔源性视网膜脱离患者，施行经平坦部入路玻璃体切除术，充分切除残留玻璃体后，行气液交换复位视网膜，确保裂孔周围视网膜下液充分排出后激光封闭视网膜裂孔，使用无菌空气行玻璃体腔填充。术后患者严格俯卧位24h。主要观察指标为视网膜初始及最终复位成功率，最佳矫正视力(BCVA)，次要观察指标为并发白内障及高眼压比率。

结果：共纳入符合标准且术后随访时间≥6mo患者31例31眼，脱位范围6.7±3.8个钟点位，裂孔数1.2±0.7个，脱离累及黄斑23眼(74%)，人工晶状体18眼(58%)，联合白内障超声乳化人工晶状体植入者6眼(19%)。入组患者Ⅰ期视网膜复位成功率87%(27/31)，最终视网膜复位成功率100%(31/31)，发生一过性眼压升高者5眼(16%)。术后6mo时BCVA(LogMAR)由术前2.17±1.27改善至0.53±0.25(P<0.001)。

结论：对于具有玻璃体视网膜手术史的不合并严重PVR的上方裂孔源性视网膜脱离患者，采用玻璃体切除术联合空气填充，可取得较高的视网膜复位成功率，且具有术后俯卧时间短，并发症少等优点。

METHODS: Retrospective analysis of the inpatients in our hospital from November 2017 to October 2019. Patients with RRD caused by superior break(s)who had underwent previous vitreoretinal surgeries and the proliferative vitreoretinopathy less than PVR-C1 were enrolled. For treatment, patients underwent PPV combined with air tamponade. During the operation, the residual vitreous cortex was fully removed, and the subretinal fluid was aspirated from retinal break(s)as much as possible. Make sure the subretinal fluid around the hole was fully drained. Then firmly laser spots were accomplished to seal the retinal break(s). Finally, filtered air was left in the vitreous cavity as tamponade agent. The patients were informed to keep a prone position for 24h postoperation. The primary outcomes were primary and final success rates, best corrected visual acuity(BCVA), and the secondary outcomes were rate of postoperative cataract surgery and high intraocular pressure.

RESULTS: Totally 31 patients(31 eyes)with follow-up time more than 6mo were included. The range of retinal detachment was 6.7±3.8h, and the number of retinal breaks was 1.2±0.7. There are 23 eyes(74%)with macular detachment and 18 eyes(58%)with intraocular lens. 6 eyes(19%)were treated with phacoemulsification and intraocular lens implantation together. The rate of primary retinal reattachment in enrolled patients was 87%(27/31), and the final reattachment rate was 100%(31/31). At the 6mo of postoperatively, the BCVA(LogMAR)increased from 2.17±1.27 to 0.53±0.25(P<0.001). Furthermore, 5 eyes(16%)developed transient ocular hypertension.

CONCLUSION: PPV with air tamponade can achieve a high success reattachment rate in the management of RRD following previous vitreoretinal surgery. It has the advantages of short postoperative prone time and fewer complications.