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治疗孔源性视网膜脱离的首选或次选手术方式——气动视网膜固定术的结果。

Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment.

机构信息

Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.

出版信息

Indian J Ophthalmol. 2018 Mar;66(3):420-425. doi: 10.4103/ijo.IJO_999_17.

Abstract

PURPOSE

To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a secondary procedure for recurrent RRD.

METHODS

We retrospectively analyzed case records of 54 patients (54 eyes) who underwent PR for RRD by injecting 0.3 ml of perfluoropropane (C3F8) in the vitreous cavity and cryopexy to break in the same sitting, followed by positioning.

RESULTS

A total 54 eyes of 54 patients aged between 17 and 84 years (mean - 51.3, median - 53 years) were included in the study. Except five eyes, all had breaks in the superior quadrants. The RRD ranged from 1 quadrant to 4 quadrants. Twenty-eight eyes (51.8%) were phakic and 26 (48.1%) were pseudophakic. The follow-up ranged from 6 to 144 months. In 25 eyes (46.2%), PR was the primary intervention and was successful in 15 (60%) eyes with a significant visual improvement (P = 0.023). Twenty-nine eyes (52.7%) with failed scleral buckle or failed pars plana vitrectomy underwent PR with a success rate of 65.5% and significant visual improvement (P = 0.0017). Progression of proliferative vitreoretinopathy changes (40%) was the most common cause of failure. The success rate was higher in phakic eyes, eyes with attached macula, superior breaks, superior RRD, and RRD limited to 3 quadrants or less.

CONCLUSION

PR remains a minimally invasive procedure which can be used primarily or as a salvage procedure in failed surgery with moderately good success rate and minimal complications. One-step procedure reduces patient visits and ensures adequate treatment of the break.

摘要

目的

报告行玻璃体腔注气(PR)联合冷凝治疗孔源性视网膜脱离(RRD)或治疗复发性 RRD 的结果。

方法

回顾性分析了 54 例(54 只眼)RRD 患者的临床资料,所有患者均在同一次手术中行玻璃体腔注气(0.3ml 全氟丙烷,C3F8)和冷凝治疗,裂孔位于上方象限的患者行巩膜扣带术或巩膜外加压术联合裂孔外冷凝治疗。

结果

54 例(54 只眼)患者年龄 17 至 84 岁(平均年龄 51.3 岁,中位数年龄 53 岁)。除 5 只眼外,所有患者的裂孔均位于上方象限,视网膜脱离累及 1 个象限至 4 个象限。28 只眼(51.8%)为晶状体眼,26 只眼(48.1%)为人工晶状体眼。随访时间 6 至 144 个月。25 只眼(46.2%)行 PR 作为初始治疗,15 只眼(60%)治疗成功,视力显著提高(P = 0.023)。29 只眼(52.7%)行巩膜扣带术或巩膜外加压术联合裂孔外冷凝治疗失败后行 PR,成功率为 65.5%,视力显著提高(P = 0.0017)。增殖性玻璃体视网膜病变(40%)进展是治疗失败的最常见原因。晶状体眼、视网膜脱离累及黄斑区、裂孔位于上方象限、上方视网膜脱离、视网膜脱离累及 3 个象限或以下的患者治疗成功率较高。

结论

PR 仍然是一种微创治疗方法,可作为初次治疗或治疗失败后的挽救性治疗,成功率中等,并发症少。一步治疗可减少患者就诊次数,确保裂孔得到充分治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0ad3/5859599/25008b29b193/IJO-66-420-g005.jpg

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