摘要:
目的 观察微创玻璃体切割手术(MIV)联合改良脉络膜上腔引流治疗脉络膜脱离型视网膜脱离(RRDCD)的疗效.方法 前瞻性临床研究.临床检查确诊的RRDCD患者27例27只眼纳入研究.其中,男性16例,女性11例;均为单眼.平均年龄(53.67±14.82)岁;平均眼压(8.20±2.10) mmHg(1 mmHg=0.133 kPa);平均最小分辨角对数(logMAR)最佳矫正视力(BCVA)为1.87±0.58.所有患眼均行23GMIV联合改良脉络膜上腔引流手术,手术中利用1 ml注射针头和23G穿刺套管进行微创脉络膜液体引流.手术后随访3个月,观察手术后1、10d,1、3个月的BCVA、眼压、视网膜复位率及手术并发症等情况.结果 手术后1、10d,1、3个月平均logMAR BCVA分别为1.62±0.67、1.51±0.63、1.39±0.54、1.32±0.56;平均眼压分别为(13.47±5.06)、(14.43±4.09)、(14.89±4.30)、(15.38±3.37) mmHg.与手术前logMAR BCVA、眼压比较,差异均有统计学意义(F=6.19、15.21,P<0.05).手术后1、10d所有患眼视网膜均复位良好,占100.0%;手术后1、3个月,视网膜复位良好者为24、23只眼,分别占88.9%、85.2%.随访期间未发生感染性眼内炎、脉络膜上腔出血等严重手术并发症.结论 MIV联合改良脉络膜上腔引流手术治疗RRDCD可提高患眼裂孔闭合率,改善视力;治疗RRDCD安全有效.%Objective To observe the clinical effect of minimally invasive vitreoretinal (MIV) surgery combined with a modified suprachoroidal drainage surgery for retinal detachment associated with choroidal detachment (RRDCD).Methods A prospective clinical study.A total of 27 patients (27eyes) diagnosed as RRDCD were recruited in this study.There were 16 males and 11 females,with an average of (53.67± 14.82) years.The mean intraocular pressure (IOP) was (8.2± 2.1) mmHg (1 mmHg=0.133 kPa) and best corrected visual acuity (BCVA) of minimum resolution angle logarithm (logMAR) was 1.87±0.58.All subjects underwent 23G MIV combined a modified suprachoroidal drainage surgery,which 23G stab knife and 1 ml syringe needle were used for surgery.The visual outcome,IOP,rate of retinal reattachment and complications were comparatively analyzed preoperatively and postoperatively.Results At 1 day,10 days,1 month and 3 months after surgery,the average of logMAR BCVA were 1.62 ± 0.67,1.51 ± 0.63,1.39 ± 0.54,1.32± 0.56 and the mean of IOP were (13.47 ± 5.06),(14.43 ± 4.09),(14.89 ± 4.30),(15.38 ± 3.37) mmHg,respectively.There were significant differences of logMAR BCVA and IOP between before and after surgery (F=6.19,15.21;P<0.05).Retinal reattachments were achieved in 27 eyes (100%) at 1 day and 10 days after surgery.At 1 month and 3 months after surgery,the rate of retinal reattachment were 88.89% (24 eyes) and 85.19% (23 eyes),respectively.No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits.Conclusion MIV combined with a modified suprachoroidal drainage surgery is an effective and safe treatment for RRDCD,which can promote retina tear closure,improve visual acuity.