Khan Muhammad Tariq, Jan Sanaullah, Karim Samina, Iqbal Sophia, Saeed Nasir
Khyber Institute of Ophthalmic Medical Sciences, Peshawar.
J Pak Med Assoc. 2010 Sep;60(9):754-7.
To study the outcome of conventional scleral buckling procedures performed for primary rhegmatogenous retinal detachment.
This prospective study was conducted at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan from 02-08-2008 to 29-04-2009. The outcome of fifty-six consecutive cases, operated in nine months duration, for primary rhegmatogenous retinal detachment using scleral buckling procedures, were analyzed prospectively. The main outcome measure was anatomically reattached retina at two weeks postoperative follow-up.
Overall success rate was 85.71% (48 of 56 cases) at 2-weeks post-operative follow-up. The most common intra-operative complication was sub-retinal haemorrhage (23.21% cases), and the most common complication at first post-operative day was increased intra-ocular pressure (IOP), (21.43% cases). The raised pressure was transient in most cases, and only 2 (3.57%) had elevated IOP at 2-weeks post-op follow-up. Choroidal detachment was the second commonest post-operative complication (10.7%) The un-aided visual acuity was PL or HM in 32 (57.14%) cases and better than 6/60 in 3 (5.36%) cases pre-operatively. This improved to PL/HM in 12 (21.43%) and better than 6/60 in 16 (28.57%) cases post-operatively. Not very significant improvement in vision despite flat retina was found to be due to late presentation of patients, high grade PVR (Grade-C) in 24 (42.86%) cases and pre-operative 'off' macula in 52 (92.86%) cases, at a short-term follow up.
Scleral buckling procedures are still effective in the treatment of primary rhegmatogenous retinal detachment even in high-grade PVR cases. A fairly good success rate can be achieved by adopting the appropriate procedures.
研究原发性孔源性视网膜脱离行传统巩膜扣带术的疗效。
本前瞻性研究于2008年8月2日至2009年4月29日在巴基斯坦白沙瓦哈亚塔巴德医学中心的开伯眼科医学研究所进行。对连续56例在9个月内采用巩膜扣带术治疗原发性孔源性视网膜脱离的病例的疗效进行前瞻性分析。主要观察指标为术后2周视网膜解剖复位情况。
术后2周随访时总体成功率为85.71%（56例中的48例）。术中最常见的并发症是视网膜下出血（23.21%的病例），术后第1天最常见的并发症是眼压升高（21.43%的病例）。大多数情况下眼压升高是短暂的，术后2周随访时只有2例（3.57%）眼压仍高。脉络膜脱离是第二常见的术后并发症（10.7%）。术前32例（57.14%）患者的裸眼视力为光感或手动，3例（5.36%）患者的裸眼视力优于6/60。术后12例（21.43%）患者的视力改善为光感/手动，16例（28.57%）患者的视力优于6/60。短期随访发现，尽管视网膜平复，但视力改善不显著，原因是患者就诊较晚、24例（42.86%）患者存在高级别增殖性玻璃体视网膜病变（C级）以及52例（92.86%）患者术前黄斑脱离。
即使在高级别增殖性玻璃体视网膜病变的病例中，巩膜扣带术在治疗原发性孔源性视网膜脱离方面仍然有效。采用适当的手术方法可获得相当高的成功率。
