Morel C, Doan S, Rivoal O, Ameline B, Monin C, Larricart P
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris.
J Fr Ophtalmol. 1998 May;21(5):315-20.
To assess the long term anatomic and functional follow-up of large relaxing retinotomies performed with liquid perfluorocarbon in severe vitreoretinal proliferation surgery.
A large relaxing retinotomy (more than 90 degrees) was realized in 40 eyes of 39 patients for anterior vitreoretinal proliferation (30 rhegmatogen retinal detachments, 8 intraocular foreign bodies, 2 ocular traumas). Follow-up was always longer than 6 months. Vitreoretinal proliferation secondary to ischemic or inflammatory retinopathy were excluded. The liquid perfluorocarbon was perfluorodecalin and was used for all eyes, as well as final intraocular tamponade by silicon oil ended every intervention.
Sixty-seven % of patients had already had a former vitrectomy, and 75% a retinal surgery. Mean size retinectomy was 170 degrees. Nine patients underwent a new vitreoretinal procedure which included in 7 cases a necessary new retinectomy. Silicon oil could be removed in 55%, after a mean period of 6, 5 months. Mean time follow-up was 13 months. At the end of follow-up, 80% of retina were attached. Visual acuity remained low with 25% equal to 1/20 or more; 45% of eyes increased their acuity, 25% remained stable and 30% worsened. Main complications were epimacular proliferation, keratopathy and increased intraocular pressure.
Relaxing retinotomies provide satisfying anatomic results and allow a preservation of some visual function. The use of liquid perfluorocarbons facilitates their realization. The initial size of retinectomy should be sufficient.
评估在严重玻璃体视网膜增殖手术中使用液态全氟碳化物进行大型视网膜松解切开术的长期解剖学和功能随访结果。
对39例患者的40只眼进行了大型视网膜松解切开术(超过90度),用于治疗前部玻璃体视网膜增殖(30例孔源性视网膜脱离、8例眼内异物、2例眼外伤)。随访时间均超过6个月。排除缺血性或炎性视网膜病变继发的玻璃体视网膜增殖。所有眼均使用全氟萘烷作为液态全氟碳化物,并在每次干预结束时用硅油进行最终眼内填塞。
67%的患者曾接受过玻璃体切除术,75%的患者接受过视网膜手术。视网膜切开术的平均大小为170度。9例患者接受了新的玻璃体视网膜手术,其中7例需要进行新的视网膜切开术。平均6.5个月后,55%的患者能够取出硅油。平均随访时间为13个月。随访结束时,80%的视网膜复位。视力仍较低,25%的患者视力等于或优于1/20;45%的患眼视力提高,25%的患眼视力稳定,30%的患眼视力下降。主要并发症为黄斑前增殖、角膜病变和眼压升高。
视网膜松解切开术可提供满意的解剖学结果,并能保留一定的视功能。液态全氟碳化物的使用有助于手术的实施。视网膜切开术的初始大小应足够。