Friberg T R, Eller A W
Department of Ophthalmology, The Eye & Ear Institute, and University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Ophthalmic Surg Lasers. 2001 Jan-Feb;32(1):13-8.
Although pneumatic retinopexy was introduced for the repair of primary retinal detachments, we have had excellent long-term success in employing this technique along with laser photocoagulation following failure of routine scleral buckle surgery in nonvitrectomized eyes over the last 10 years.
We categorized a consecutive series of 40 eyes that failed primary scleral buckling surgery and had at least six months follow-up. Eyes were separated into two groups: those with 1) subretinal fluid persisting or developing during the first 14 days after surgery or 2) those accumulating subretinal fluid at least 14 days after initially successful anatomic reattachment of the retina.
In these groups, 36 of the 40 eyes (90%) were successfully reattached using outpatient pneumatic retinopexy alone. Complications were limited to the production of new retinal breaks in 5 patients. The 4 pneumatic retinopexy failures were all subsequently treated successfully with either scleral buckle revision or vitrectomy.
We believe that laser pneumatic retinopexy repair of recurrent retinal detachments following scleral buckle and without significant proliferation vitreoretinopathy (PVR) should be considered ahead of conventional surgical intraoperative techniques. Laser pneumatic retinopexy may be a very successful procedure for the treatment of recurrent retinal detachments after failed scleral buckle surgery. In a consecutive series of 40 eyes with recurrent retinal detachment, we were able to repair 36 with pneumatic retinopexy alone.
尽管气体视网膜固定术已被用于原发性视网膜脱离的修复,但在过去10年中,对于非玻璃体切除的眼睛,在常规巩膜扣带手术失败后,我们将该技术与激光光凝术联合应用取得了优异的长期效果。
我们将连续40只原发性巩膜扣带手术失败且至少随访6个月的眼睛进行分类。这些眼睛被分为两组:1)术后前14天内视网膜下液持续存在或出现的眼睛,或2)视网膜最初成功解剖复位至少14天后视网膜下液积聚的眼睛。
在这些组中,40只眼中的36只(90%)仅通过门诊气体视网膜固定术成功复位。并发症仅限于5例患者出现新的视网膜裂孔。4例气体视网膜固定术失败的患者随后均通过巩膜扣带术修复或玻璃体切除术成功治疗。
我们认为,对于巩膜扣带术后复发性视网膜脱离且无明显增殖性玻璃体视网膜病变(PVR)的情况,应优先考虑激光气体视网膜固定术修复,而非传统的手术中技术。激光气体视网膜固定术可能是治疗巩膜扣带手术失败后复发性视网膜脱离的一种非常成功的方法。在连续40只复发性视网膜脱离的眼睛中,我们仅通过气体视网膜固定术就成功修复了36只。