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目的 探讨保留透明晶状体的玻璃体视网膜手术治疗伴有增生性玻璃体视网膜病变 (pro-liferative vitreoretinopathy,PVR)的巨大视网膜裂孔 (giant retinal tears,GRT)的手术方法及效果。 方法 对 1997年 7月至 1999年 7月间 30例 GRT患者的 31只患眼作回顾性分析。手术方法包括三通道睫状体平部玻璃体切割、膜剥离、视网膜切开与切除、全氟萘烷使用、眼内激光光凝、硅油或 C2 F6 气体填充。术中2 8只眼保留透明晶状体 ,术后追踪时间 11～ 34个月 (平均 12 .5个月 )。 结果 GRT视网膜完全解剖复位2 9只眼 ,部分复位 1只眼 ,有效率为 96 .8%。硅油填充 2 7只眼 ,平均 6 .0个月后行硅油取出 ,追踪 6～ 19个月 ,2 6只眼视网膜全部复位 ,1只眼失败。3只眼行白内障手术摘除 ,最终保留晶状体 2 5只眼 ,其中并发晶状体后囊轻度混浊 16只眼。 2 4只眼术后视力提高 ,占 77.4% ,最好的矫正视力 0 .4。 结论 保留晶状体的玻璃体切割联合应用全氟萘烷液体及硅油填充可有效的提高伴有 PVR的 GRT手术成功率及视力。
Objective To investigate the surgical treatment of giant retinal tears (GRT) associated with proliferative vitreoretinopathy (PVR) with vitreoretinal retention of clear lens. Methods Thirty-one patients with GRT from July 1997 to July 1999 were retrospectively analyzed. Surgical methods include three-channel ciliary body flat vitrectomy, membrane dissection, retinal incision and resection, perfluorodecalin use, intraocular laser photocoagulation, silicone oil or C2 F6 gas filling. During the operation, 28 eyes had a clear lens and the follow-up time ranged from 11 to 34 months (average 12.5 months). Results The complete anatomic reduction of GRT retina was performed in 29 eyes and partly in one eye. The effective rate was 96.8%. Filled with silicone oil 27 eyes, an average of 6.0 months after the removal of silicone oil, tracking 6 to 19 months, 26 all eyes retinal reset, one eye failed. Three eyes underwent cataract surgery and finally retained 25 eyes of the lens, of which 16 cases were slightly turbid posterior capsule of the lens. 24 eyes improved visual acuity, accounting for 77.4%, the best corrected visual acuity 0 .4. Conclusions Vitrectomy with preserved lens combined with perfluorodecalin liquid and silicone oil filling can effectively improve the success rate and visual acuity of GRT with PVR.