一种可调控自封闭排视网膜下液切口.docVIP

一种可调控自封闭排视网膜下液切口 　关键词：视网膜脱离 【摘要】目的探讨一种可调控自封闭巩膜切口排视网膜下液的可行性及手术效果。方法在一组连续78例（79眼）简单裂孔性视网膜脱离外路显微手术中，用11号尖刀片，在要排液的部位以45°角倾斜、放射状刺入巩膜约1～2mm，形成一种用刀片压住巩膜切口下唇，视网膜下液即流出，不压下唇即封闭的巩膜切口。显微镜下观察排液孔内外口的情况。术后详细观察手术效果。结果成功排出视网膜下液77眼（97.5%），其中一次性排液成功73眼（92.4%），2眼调整位置后排液成功，2眼由于眼压较低需借助皮下注射针头穿刺脉络膜排液成功。未能排除视网膜下液2眼。排液并发症有视网膜嵌顿3眼，视网膜穿孔1眼，视网膜下少量出血11眼。这些并发症经及时处理均未出现严重后遗症。一次手术成功率92.4%（73眼）。再次手术后视网膜复位4眼。最终成功率为97.5%（77眼）。术后视力：≤0.1者26眼，0.2~0.4者29眼，0.5~0.9者14眼，≥1.0者10眼，视力较术前显著提高（P＜0.01）。结论可调控自封闭巩膜切口排视网膜下液的技术具有简单、快速、安全和有效的优点。 　　【关键词】视网膜脱离；显微手术；排视网膜下液 　　Acontrollableself-sealingsclerotomyfordrainageofsubretinalfluid 　　　 　【Abstract】ObjectiveToevaluatethefeasibilityandsurgicaleffectsofacontrollableself-sealingsclerotomyfordrainageofsubretinalfluid(SRF).Methods79eyesofseventy-eightconsecutivepatientswithrhegmatogenousretinaldetachment(RD)underwentscleralbuckleandexternaldrainageofSRFwithasharpknifeunderthemicroscope.TheSRFwasdrainagedbyatechniquewherebyaradialscleralpenetratingof1~2mmdeepwasmadewithasharpknifein45obliqueangle.Thus,theoutflowofSRFcanbecontrolled.TheSRFwasdischargedastheinferiorvalveofthesclerotomywasbeenpressingandthedrainagewasstoppedasthepressingwasrelieved.Theinternalincisionsofthedrainagewereexaminedunderthemicroscopewiththescleralindentation.Thedrainageeffectsandmicrosurgicalreattachmentratewereobserved.ResultsTheSRFwasdrainedsuccessfullyin77eyes,amongthem,initialsuccessfuldrainagewasobtainedin73eyesandthesecondwasgotin2eyesafterchangingthesiteofdrainage.Duetolowerintraocularpressure,asubdermicneedwasusedtopenetratethechoroidinremaindtwoeyes.TheSRFwasunabletobeexpelledin2eyes.Thecomplicationsofdrainageincludedretinalincacerationin3eyes,retinalperforationinoneeyeandminimumhemorrhagebeneaththeretinain11eyes.Thesecomplicationswerealltreatedintimetoavoidserioussequelaes.Oneoperationwasdonein73eyesandoncemoreoperationswereneededin6eyes,buttwopatientsrefusedresurgeryforRD.SRFabsorbedcompletelyandtheretinalgotreattachmentin77eyesatlast.Thepostoperativevisualacuitywaslevel≤0.1in26eyes,0