Chang Yo-Chen, Chiu Li-Yi, Kao Tzu-En, Cheng Wen-Hsin, Chen Ting-An, Wu Wen-Chuan
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
BMC Ophthalmol. 2018 Oct 22;18(1):272. doi: 10.1186/s12886-018-0938-4.
Giant retinal tear is usually challenging among retinal detachment with recurrent rate up to 45%. Here we presented a case of giant retinal tear being treated by microincision vitrectomy and retinal tacks fixation.
A 53-year-old male presented to our hospital with blurred vision of his right eye for one week with floaters and obscured sensation over nasal visual field. Ocular examination showed a 120 degree giant tear with large inverted flap and retinal detachment of his right eye. The BCVA was only naming digit. Under the impression of giant retinal tear with retinal detachment, 23-gauge pars plana vitrectomy were performed using Constellation high speed vitrectomy system and Topcon non-contact wide angle viewing system. During surgery, the vitreous was removed and perfluorocarbon liquids (PFCL) was injected to help unfolding the large inverted retinal flap. Three retinal tacks were applied to help fixating the large inverted retinal flap. Then, fluid-gas exchange, endolaser photocoagulation and intraocular silicone oil tamponade were performed as well. Initial reattachment of his right retina was achieved and his best corrected visual acuity improved to 0.3 of his right eye postoperatively. There was no recurrent retinal detachment during follow up period of 19 months.
Primary microincision vitrectomy using wide-angle viewing system with intraoperative perfluorocarbon liquids (PFCL) assistant, retinal tacks fixation and intraocular silicone oil tamponade appears to be safe and feasible for managing giant retinal tear with retinal detachment.
巨大视网膜裂孔在视网膜脱离中通常具有挑战性，复发率高达45%。在此，我们报告一例采用微创玻璃体切除术和视网膜钉固定术治疗的巨大视网膜裂孔病例。
一名53岁男性因右眼视力模糊一周，伴有飞蚊症和鼻侧视野遮挡感前来我院就诊。眼部检查显示右眼有一个120度的巨大裂孔，伴有大的倒瓣和视网膜脱离。最佳矫正视力仅能数指。在诊断为巨大视网膜裂孔伴视网膜脱离后，使用Constellation高速玻璃体切除系统和Topcon非接触广角观察系统进行了23G经睫状体平坦部玻璃体切除术。手术过程中，切除玻璃体并注入全氟碳液体（PFCL）以帮助展开大的倒转视网膜瓣。应用三个视网膜钉来帮助固定大的倒转视网膜瓣。然后，进行了液-气交换、视网膜激光光凝和眼内硅油填充。术后右眼视网膜初步复位，最佳矫正视力提高到0.3。在19个月的随访期内未发生视网膜脱离复发。
使用广角观察系统、术中全氟碳液体（PFCL）辅助、视网膜钉固定和眼内硅油填充的原发性微创玻璃体切除术对于治疗巨大视网膜裂孔伴视网膜脱离似乎是安全可行的。
