上方球形视网膜脱离术中行玻璃体内BSS注入与术毕空气充填效果比较

Comparison of intraoperative balanced salt solution injection or postoperative air filling for superior bullous retinal detachment

摘要:

目的：观察巩膜外放液后术中行玻璃体内平衡盐溶液(BSS)注入适当升高眼压，再行巩膜外垫压(SB)治疗原发性上方球形视网膜脱离(SBRD)的效果，并与常规术式(无任何玻璃体内填充)及术毕玻璃体内注入消毒空气的效果进行比较。

方法：回顾性病例对照研究。2018-01/2022-12因SBRD在西京医院眼科行SB治疗的72例73眼患者被纳入研究。所有患者术中均行巩膜外放液。根据放液后是否行玻璃体注射升高眼压和注射物不同，患者被分为三组：常规手术组不做任何玻璃体内注射24例24眼、术毕注入消毒空气组(空气组)23例23眼，以及术中注入BSS组(BSS组)25例26眼。所有患者至少随访至视网膜下液完全吸收。比较各组平均手术时间、术后早期眼压、视网膜复位、视网膜下液吸收、视力(LogMAR)和主要并发症等差异。

结果：所有患者均顺利完成手术。常规手术组、空气组和BSS组平均手术时间分别为63.17±13.22、61.65±15.55、57.30±11.70 min，三组间无差别(F=0.825，P=0.443)。术后1 d，常规手术组、空气组和BSS组平均眼压分别为13.69±2.69、16.40±2.86、18.35±2.88 mmHg，空气组和BSS组平均眼压高于常规手术组(F=17.18，P<0.001)。三组中单次手术的视网膜复位率分别为88%、96%和100%。术后1 d，常规手术组、空气组和BSS组平均BCVA分别为0.71±0.42、0.59±0.44、0.91±0.50，均较术前提高(均P<0.05)，而三组间无差别(F=3.046，P>0.05)。手术后，常规手术组和空气组分别有1眼出现视网膜下出血，空气组1眼出现新裂孔而导致局限性视网膜脱离。

结论：针对SBRD患者SB术中放液后出现的低眼压，采取BSS玻璃体内注射适当升高眼压再完成手术，可提高手术成功率，减少术后并发症。这种方法对经选择的SBRD患者是安全和有效的。

Abstract:

AIM: To observe the outcome of intravitreal balanced salt solution(BSS)injection to increase intraocular pressure(IOP)after extrascleral subretinal fluid drainage, then scleral buckling(SB)to treat superior bullous retinal detachment(SBRD), and compare it with the effect of conventional surgery(without any intravitreal filling)and postoperative air filling.

METHODS: Retrospective case-control study. A total of 72 patients(73 eyes)who underwent SB for SBRD from January 2018 to December 2022 in ophthalmology department of Xijing Hospital were included. The extrascleral subretinal fluid drainage was performed in all eyes. According to whether intravitreal injection was performed and different injections, patients were divided into three groups: with 24 cases(24 eyes)in the conventional group(no intravitreal injection), 23 cases(23 eyes)in the air group(sterile air was injected after surgery), and 25 cases(26 eyes)in the BSS group(BSS was injected during extrascleral subretinal fluid drainage). All patients were followed up until subretinal fluid was absorbed completely. The average surgery time, postoperative IOP, retinal reattachment rate, subretinal fluid absorption, visual acuity(LogMAR)and major complications were compared.

RESULTS: All surgeries were completed successfully. The average surgery time of the conventional group, air group and BSS group were 63.17±13.22, 61.65±15.55 and 57.30±11.70 min, respectively. There had no significant difference among these groups(F=0.825, P=0.443). On the first post-operative day, the average IOP of the conventional group, air group and BSS group were 13.69±2.69, 16.40±2.86 and 18.35±2.88 mmHg, respectively. The average IOP of the air group and the BSS group were significant higher than that of the conventional group(F=17.18, P<0.001). Primary reattachment rates were 88%, 96%, and 100%, respectively. The postoperative BCVA was 0.71±0.42, 0.59±0.44, and 0.91±0.50, respectively, which were significantly higher than those before operation(all P<0.05), but there was no significant difference among groups(F=3.046, P>0.05). The main complications included subretinal hemorrhage in 1 eye from the conventional group and 1 eye from the air group, and a new retinal tear in 1 eye from the air group, resulting in localized retinal detachment.

CONCLUSIONS: For SBRD patients with hypotony during SB surgery, intravitreal injection of BSS to properly increase the IOP and then complete the surgery can improve the reattachment rate and reduce postoperative complications. This method is safe and effective for selected SBRD patients.