25G玻璃体切割联合巩膜扣带术治疗巨大裂孔性视网膜脱离临床分析

Clinical Analysis of 25G Vitrectomy Combined with Scleral Buckling for Giant Retinal Detachment

摘要: 目的：探讨应用微创玻璃体切割联合巩膜扣带术治疗巨大裂孔性视网膜脱离的手术效果。方法：回顾性分析2019年1月到2021年1月深圳爱尔眼科医院眼底病科收治的有完整资料的巨大裂孔性视网膜脱离的患者16例(共17眼)。患者均行25G自闭式玻璃体切割联合巩膜扣带术，术中联合应用视网膜激光、C3F8、无菌空气、硅油注入等综合方法治疗，随访6个月，对视网膜复位情况、术中、术后并发症，手术前后眼部参数进行比较，观察临床疗效。结果：首次手术后17只眼视网膜解剖上完全复位，未见明显严重并发症。随访结束时，16只眼睛(94.1%)视网膜获得完全解剖复位(去除硅油后或气体吸收后)。随访期结束时(8 ± 3个月)，患者的术后最佳矫正视力较术前提高(P < 0.05)，差异有统计学意义(P < 0.05)。结论：25G微创玻璃体切割联合巩膜扣带术治疗巨大裂孔性视网膜脱离是一种安全有效且手术成功率高的方法，值得临床推广应用。在这个复杂的手术过程中，合并巩膜扣带术治疗可能有助于提高视网膜成功复位率。

Abstract: Objective: To investigate the surgical effect of minimally invasive vitrectomy combined with scleral buckling in the treatment of giant retinal detachment. Methods: A retrospective analysis was per-formed on 16 patients (17 eyes) with giant tear retinal detachment who were admitted to the De-partment of Ophthalmology, Shenzhen Aier Eye Hospital from January 2019 to January 2021. All patients underwent 25G self-closing vitrectomy combined with scleral buckling, combined with retinal laser, C3F8, sterile air, silicone oil injection and other comprehensive methods during the operation. The patients were followed up for 6 months. Complications, ocular parameters before and after surgery, were compared, and clinical efficacy was observed. Results: The retinas of 17 eyes were completely reattached after the first operation, and no serious complications were found. At the end of follow-up, 16 eyes (94.1%) achieved complete anatomical reduction of the retina (after removal of silicone oil or after gas absorption). At the end of the follow-up period (8 ± 3 months), the postoperative best corrected visual acuity of the patients was improved compared with that before the operation (P < 0.05), and the difference was statistically significant (P < 0.05). Conclusion: 25G minimally invasive vitrectomy combined with scleral buckling in the treatment of giant retinal de-tachment is a safe and effective method with high surgical success rate, which is worthy of clinical application. In this complex surgical procedure, combined scleral buckling may help improve the rate of successful retinal reattachment.