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与脉络膜缺损相关的视网膜脱离的手术治疗

Surgical management of retinal detachments related to coloboma of the choroid.

作者信息

Gopal L, Badrinath S S, Sharma T, Parikh S N, Shanmugam M S, Bhende P S, Agrawal R, Deshpande D A

机构信息

Sankara Nethralaya, Medical and Vision Research Foundations, Chennai, India.

出版信息

Ophthalmology. 1998 May;105(5):804-9. doi: 10.1016/S0161-6420(98)95018-7.

Abstract

OBJECTIVE

This study aimed to develop a rationale for the management of retinal detachments related to choroidal coloboma and to study the outcome of their management.

DESIGN

The study design was a retrospective study.

PARTICIPANTS

A total of 85 eyes of 81 patients with retinal detachments related to coloboma of the choroid participated.

INTERVENTION

All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil (80 eyes) or perfluropropane gas (5 eyes). Behavior of the retina on fluid-air exchange was used to guide the further steps of surgery. Endolaser was performed along the coloboma border. Silicone oil was removed in 80% of eyes. The main outcome measures were retinal reattachment and visual recovery.

RESULTS

Recurrent retinal detachment occurred in 16.3% of silicone oil-filled eyes and 60% of gas-filled eyes. After silicone oil removal, 15.6% of eyes had recurrent retinal detachment. After a mean follow-up of 13.4 months, 81.2% of eyes had attached retina and 69.4% recovered equal to or better than 10/200 visual acuity.

CONCLUSION

Retinal detachment secondary to coloboma of choroid is treated best by pars plana vitrectomy along with silicone oil tamponade. Gas tamponade has limited indications. Clinical evaluation of the extent of retinal detachment within the colobomatous area and the behavior of the retina on fluid-air exchange help the authors understand the pathogenesis of the retinal detachment and plan a rational therapy.

摘要

目的

本研究旨在为与脉络膜缺损相关的视网膜脱离的治疗制定理论依据,并研究其治疗结果。

设计

本研究设计为回顾性研究。

参与者

共有81例患有与脉络膜缺损相关视网膜脱离的患者的85只眼参与研究。

干预措施

所有患眼均接受了玻璃体切除联合硅油(80只眼)或全氟丙烷气体(5只眼)内填充术。利用视网膜在液气交换时的表现来指导手术的进一步操作。沿缺损边缘进行视网膜光凝。80%的患眼取出了硅油。主要观察指标为视网膜复位和视力恢复情况。

结果

硅油填充眼复发性视网膜脱离发生率为16.3%,气体填充眼为60%。取出硅油后,15.6%的患眼发生复发性视网膜脱离。平均随访13.4个月后,81.2%的患眼视网膜复位,69.4%的患眼视力恢复至10/200或更好。

结论

脉络膜缺损继发的视网膜脱离采用玻璃体切除联合硅油填充治疗效果最佳。气体填充的适应证有限。对缺损区内视网膜脱离范围及视网膜在液气交换时表现的临床评估有助于术者了解视网膜脱离的发病机制并制定合理的治疗方案。

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