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目的由解剖和视功能疗效评价无扣带玻璃体手术治疗较复杂的非增殖型裂孔性视网膜脱离的应用价值及其优势。方法选择无明显PVR裂孔性视网膜脱离63例63眼,针对大小、形态、分布等较复杂的撕裂孔,行玻璃体切割、巩膜外冷凝及眼内气体充填,均无外加压。随访11～25个月,以视力、眼底彩照及术后OCT为主要评价指标。结果确诊赤道前后裂孔108个,其中术中发现25个。一次性手术视网膜复位率95.2%(60/63),最终达100%。无术后PVR发生。术后最佳矫正视力62例不同程度提高,79.4%达0.4以上,且恢复快。OCT检查术后3个月黄斑区形态,仅37.7%(20/53)有隐匿的结构异常,其中黄斑前膜对视力有轻度影响(p=0.020)。白内障发生率23.8%(15/63)且与年龄正相关(p=0.024)。结论在技术条件允许时,首选无扣带玻璃体手术治疗非增殖型较复杂裂孔性视网膜脱离,有利于提高一次性手术复位率和视功能恢复的程度及速度,并减少并发症。
Objective To evaluate the value and advantage of non-cristobal vitrectomy in the treatment of more complicated nonproliferative retinal detachment by anatomical and visual function. Methods Sixty-three eyes (63 eyes) with no retinal detachment due to PVR were selected. No additional pressure was applied to patients with more complicated tear, such as size, shape and distribution. Vitrectomy, extra-scleral condensation and intraocular gas filling were performed. Follow-up 11 ~ 25 months, with visual acuity, fundus color photographs and postoperative OCT as the main evaluation index. The results confirmed 108 before and after the equatorial hiatus, of which 25 were found during surgery. One-time surgical retinal reattachment rate of 95.2% (60/63), eventually up to 100%. No postoperative PVR occurred. Postoperative best corrected visual acuity in 62 cases increased to varying degrees, 79.4% of 0.4 or more, and faster recovery. OCT examined macular morphology at 3 months postoperatively, and only 37.7% (20/53) had occult structural abnormalities. The premacular membrane had a slight effect on visual acuity (p = 0.020). The incidence of cataracts was 23.8% (15/63) and age-related (p = 0.024). Conclusion When the technical conditions permit, the first choice of non-cristae vitreous surgery for non-proliferative more complicated retinal detachment is conducive to improving the one-time surgical reduction and visual function recovery degree and speed, and reduce complications.