Hirashima Takafumi, Kita Mihori, Yoshitake Shin, Hirose Miou, Oh Hideyasu
Department of Ophthalmology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan.
Clin Ophthalmol. 2011;5:1539-41. doi: 10.2147/OPTH.S25730. Epub 2011 Oct 21.
This paper reports a young patient with a traumatic rhegmatogenous retinal detachment and massive vitreous gel incarceration into the subretinal space, who was successfully treated with 23-gauge transconjunctival vitrectomy.
An 11-year-old boy was referred to the authors' clinic with traumatic retinal detachment in the right eye, 2 weeks after ocular contusion in a baseball accident. At the time of the injury, emergency fundus examination by his local doctor had revealed vitreous hemorrhage in the inferior quadrant of the right eye. Visual acuity was 1.5. He had continued to play baseball as usual for 2 weeks after the injury. At his first visit to the authors' clinic, fundus examination showed a highly bullous retinal detachment involving the inferior two quadrants, associated with multiple irregular retinal breaks. There was an oval hole in the inferior quadrant which was 10-disc diameter × 5-disc diameter in size and was surrounded by edematous and hemorrhagic retina. The macula remained attached. Absolute rest for 4 hours in the supine position with binocular occlusion did not diminish the height of the retinal detachment. A 23-gauge three-port pars plana vitrectomy combined with 360° circumferential buckling was performed under general anesthesia. The lens was retained. Incarceration of massive vitreous gel, including vitreous hemorrhage into the subretinal space through the largest break, was observed during vitrectomy. Reattachment of the retina was achieved by fluid-air exchange and internal tamponade using SF(6) gas. At follow-up at 9 months, the retina remained attached and visual acuity in the right eye was 1.2.
本文报告一名年轻患者，患有外伤性孔源性视网膜脱离且大量玻璃体凝胶嵌顿于视网膜下间隙，通过23G经结膜玻璃体切除术成功治疗。
一名11岁男孩在棒球事故中眼部挫伤2周后，因右眼外伤性视网膜脱离被转诊至作者所在诊所。受伤时，当地医生的急诊眼底检查发现右眼下方象限玻璃体出血。视力为1.5。受伤后他照常继续打了2周棒球。在他首次就诊于作者诊所时，眼底检查显示高度隆起的视网膜脱离累及下方两个象限，伴有多个不规则视网膜裂孔。下方象限有一个椭圆形裂孔，大小为10视盘直径×5视盘直径，周围是水肿和出血的视网膜。黄斑仍附着。双眼遮盖仰卧位绝对休息4小时并未降低视网膜脱离的高度。在全身麻醉下进行了23G三通道平坦部玻璃体切除术并联合360°环形外加压。晶状体予以保留。玻璃体切除术中观察到大量玻璃体凝胶，包括玻璃体出血通过最大的裂孔嵌顿于视网膜下间隙。通过液气交换及使用SF(6)气体进行眼内填充使视网膜复位。在9个月的随访中，视网膜保持附着，右眼视力为1.2。
