Conart J-B, Hubert I, Casillas M, Berrod J-P
Service d'ophtalmologie A, CHU de Nancy, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy cedex, France.
J Fr Ophtalmol. 2013 Mar;36(3):255-60. doi: 10.1016/j.jfo.2012.01.007. Epub 2012 Sep 13.
To report the results of primary scleral buckling in the treatment of uncomplicated rhegmatogenous retinal detachment in phakic eyes and to determine risk factors for failure.
Retrospective study of 100 consecutive phakic eyes undergoing surgery for uncomplicated retinal detachment. All patients underwent cryopexy, scleral buckling with hard silicone explant type 287 and in selected cases, drainage of subretinal fluid and gas tamponnade with air or SF6.
The primary anatomic success rate was 84% and 99% respectively after one or multiple procedures. The causes of failure were new breaks (50%), proliferative vitreoretinopathy (31.2%) and malposition of the scleral buckle (18.8%). Mean visual acuity improved from 0.77±0.75 logMar to 0.21±0.19 logMar (P<0.00001). Predictive risk factors for failure included extent of the detachment beyond one quadrant and multiple breaks (P=0.03). Horseshoe tears had a worse prognosis than oral dialysis or atrophic round holes (P=0.04).
Scleral buckling remains safe and effective for the treatment of uncomplicated rhegmatogenous retinal detachments in phakic eyes, especially when the extent of the detachment was less than one quadrant or in the presence of a single tear, an atrophic round hole or an oral dialysis.
报告原发性巩膜扣带术治疗有晶状体眼单纯孔源性视网膜脱离的结果，并确定手术失败的危险因素。
对100例连续接受单纯视网膜脱离手术的有晶状体眼进行回顾性研究。所有患者均接受了冷冻疗法、使用287型硬硅胶外植体的巩膜扣带术，部分病例还进行了视网膜下液引流及空气或六氟化硫气体填充。
一次或多次手术后，解剖学上的原发性成功率分别为84%和99%。手术失败的原因包括新裂孔（50%）、增殖性玻璃体视网膜病变（31.2%）和巩膜扣带位置不当（18.8%）。平均视力从0.77±0.75对数最小分辨角对数视力提高到0.21±0.19对数最小分辨角对数视力（P<0.00001）。手术失败的预测危险因素包括脱离范围超过一个象限和多个裂孔（P=0.03）。马蹄形裂孔的预后比视网膜锯齿缘离断或萎缩性圆孔更差（P=0.04）。
巩膜扣带术治疗有晶状体眼单纯孔源性视网膜脱离仍然安全有效，尤其是当脱离范围小于一个象限或存在单个裂孔、萎缩性圆孔或视网膜锯齿缘离断时。
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