目的：针对我院孔源性视网膜脱离巩膜扣带术失败的病例，分析其原因并探讨再次手术策略。

方法：单中心、回顾性、描述性研究。收集2013年8月至2023年7月期间在我院接受巩膜扣带术治疗的368例孔源性视网膜脱离患者(387眼)的临床数据。分析视网膜脱离复发的原因以及再次手术的选择。

结果：共纳入分析368例患者(387眼)，其中包括222名男性和146名女性。平均年龄为30.26±14.18岁，平均随访时间为(48.33±20.39)mo。巩膜扣带术的成功率为90.2%。有38眼出现了视网膜脱离复发的情况。根据手术记录分析巩膜扣带术失败的原因。复发原因包括：14眼(36.8%，14/38)的垫压嵴异常(位置、高度或宽度)、11眼(29.0%，11/38)的视网膜裂孔遗漏、10眼(26.3%，10/38)的增生性玻璃体视网膜病变(PVR)、以及3眼(7.9%，3/38)的新裂孔。其中，8眼(21.1%，8/38)再次进行了巩膜扣带手术，而其余30眼(78.9%，30/38)进行了经睫状体平坦部玻璃体切除术(PPV)。关于填充物，11眼(36.7%，11/30)使用了硅油，12眼(40.0%，12/30)使用了C₃F₈气体，7眼(23.3%，7/30)使用了无菌空气。

结论：巩膜扣带术治疗孔源性视网膜脱离具有较高的成功率。垫压嵴异常、手术中遗漏裂孔、增生性玻璃体视网膜病变是导致巩膜扣带术失败的主要原因。针对巩膜扣带手术失败后的复发性视网膜脱离再次手术处理，再次巩膜扣带手术、玻璃体切除手术均有着较好的手术效果。

METHODS: This was a single-center, retrospective, descriptive study. The clinical data of 368 patients(387 eyes)with RRD who underwent scleral buckling(SB)surgery between August 2013 and July 2023 at our institution were collected. The aim was to analyze the causes of recurrence and the rationale for selecting reoperation methods.

RESULTS: Totally 368 patients(387 eyes)were included in the analysis, comprising 222 males and 146 females. The average age was 30.26±14.18 years, and the mean follow-up duration was(48.33±20.39)mo. The success rate of SB surgery was 90.2%. Recurrent retinal detachment occurred in 38 eyes. Based on surgical records, the causes of SB failure were analyzed. The recurrence causes included abnormal compression ridge position(position, height, or width)in 14 eyes(36.8%, 14/38), hole omission in 11 eyes(29.0%, 11/38), proliferative vitreoretinopathy(PVR)in 10 eyes(26.3%, 10/38), and new holes in 3 eyes(7.9%, 3/38). Among these, 8 eyes(21.1%, 8/38)underwent repeat SB surgery, while the remaining 30 eyes(78.9%, 30/38)underwent pars plana vitrectomy(PPV). Regarding tamponade agents, silicone oil was used in 11 eyes(36.7%, 11/30), C₃F₈ gas in 12 eyes(40.0%, 12/30), and sterile air in 7 eyes(23.3%, 7/30).

CONCLUSION: SB surgery demonstrates a high success rate in the treatment of RRD. However, abnormal compression ridge position, missed holes during surgery, and PVR are the primary causes of SB failure. After addressing the reasons for failure, re-SB surgery or PPV can be effective alternatives.