显微镜直视下外路视网膜脱离手术探析.docVIP

显微镜直视下外路视网膜脱离手术探析 　【摘要】 目的 探讨显微镜直视下外路视网膜脱离手术的可行性。方法 孔源性视网膜脱离14例（14眼）在手术显微镜直视下行裂孔及变性区定位，在裂孔及裂孔周围行视网膜冷凝，放出视网膜下液，做硅胶填压及环扎带。最后顶起硅胶填压块，证实裂孔位于巩膜嵴前坡上，如眼压过低，则玻璃体腔内注入空气或C3F8，术后定期观察视力、玻璃体及视网膜复位情况。结果 随访1～6个月，术后视网膜裂孔均闭，完全复位14眼，视力提高14眼，矫正视力＜0.3者6眼，≥0.3者8眼，视网膜下液延缓吸收2眼，6天后完全吸收。冷凝反应：0级1眼，Ⅰ级4眼，Ⅱ级8眼，Ⅲ级1眼。结论 显微镜直视下外路视网膜脱离手术具有手术野清晰，操作简便、易掌握，手术效果良好等优点，值得临床推广应用。 【关键词】 视网膜脱离 显微手术 . 【Abstract】 Objective To evaluate the possibility of the scleral buckling surgerty of retinal detachment under surgical microscope.Methods 14 cases were the rhegmatogenous retinal detachment.14 eyes were performed the loation of retinal breaks and mutational areas under surgical microscope. The retinal cryotheropy was involved at or around the retinal breaks，drainage of subretinal fluid was involved then silicone buckling or circling were performed.At last the silicone buckling was stuck to prove that retinal breaks were located on the front part of scleral ridge.Filtered air or perfluropropane(C3F8 gas) eye pressure was too low.Visual acuity，vitreum and the condition of retinal redetachment were observed periodly after the surgeon.Results Follow up was one to six months. Retinal breaks were closed after operation.14 cases got complete redtachment.The visual acuity was improved in 14 eyes.The correct visual acuity was lower than 0.3 in 6 eyes but better than 0.3 in 8 eyes.Postponed absorption of subretinal fluid in 2 eyes and got complete absorption in 6 days.Cryotheropy reaction：0 level in 1 eye， 1 level in 4 eyes ，Ⅱ level and Ⅲ level in 8 eyes and 1 eye respectively.Conclusion Evaluation of the scleral buckling surgery of retinal detachment under surgical microsope has the merits that the scene of surgeon is clear，operation can be mastered easily and good surgical effort.Further more，it is easy to be spreaded and practised. 【Key words】 retinal detachment microsurgery 视网膜脱离是因为视网膜裂孔引起的急性致盲性疾病。常规的视网膜脱离裂孔定位及冷凝术、放液术均在双目间接检眼镜下完成，间接检眼镜具有倒像、放大倍数低、术中需反复取戴、不易掌握等缺点。2003年2月～2004年6月笔者采用同轴照明显微镜直视下外路视网膜脱离手术治疗，具有手