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用于活动性4A期早产儿视网膜病变的巩膜扣带术。

Scleral buckling surgery for active stage 4A retinopathy of prematurity.

作者信息

Hinz B J, de Juan E, Repka M X

机构信息

Vitreoretinal Service, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287-9009, USA.

出版信息

Ophthalmology. 1998 Oct;105(10):1827-30. doi: 10.1016/S0161-6420(98)91023-5.

Abstract

OBJECTIVE

To examine the effectiveness of scleral buckling surgery for active stage 4A retinopathy of prematurity.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Eight eyes of seven infants were examined. All except one had previous peripheral ablation (cryotherapy-laser) but retinal detachment was actively progressing.

INTERVENTION

Scleral buckling surgery was performed by one surgeon.

MAIN OUTCOME MEASURES

Anatomic retinal status and visual acuity outcome after average follow-up of 23 months were measured.

RESULTS

Six (75%) of eight eyes had a complete retinal reattachment (+/- macular ectopia) after a single buckling procedure. Two eyes progressed to stage 4B despite scleral buckling but after closed limbal vitrectomy with lensectomy and membrane peeling, the retinas were reattached.

CONCLUSIONS

Scleral buckling for stage 4A retinopathy of prematurity is an effective means of preventing further progression of retinal detachment. The authors believe that the effect of the buckle not only relieves vitreoretinal traction but also plays a role in preventing ischemia in the detached retina that alters the natural progression of the disease.

摘要

目的

探讨巩膜扣带术治疗活动期4A期早产儿视网膜病变的有效性。

设计

回顾性非对照病例系列。

研究对象

对7例婴儿的8只眼进行了检查。除1只眼外,其余所有眼均曾接受过周边视网膜光凝(冷冻疗法-激光),但视网膜脱离仍在进展。

干预措施

由一名外科医生实施巩膜扣带术。

主要观察指标

测量平均随访23个月后的视网膜解剖状态和视力结果。

结果

8只眼中有6只眼(75%)在单次扣带手术后视网膜完全复位(±黄斑异位)。2只眼尽管进行了巩膜扣带术仍进展至4B期,但在进行了包括晶状体切除术和膜剥除术的闭合式角膜缘玻璃体切除术后,视网膜复位。

结论

巩膜扣带术治疗4A期早产儿视网膜病变是预防视网膜脱离进一步进展的有效方法。作者认为,巩膜扣带的作用不仅在于缓解玻璃体视网膜牵拉,还在于预防脱离视网膜的缺血,从而改变疾病的自然进程。

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