视盘放射状切开术在视网膜中央静脉阻塞中应用.docVIP

视盘放射状切开术在视网膜中央静脉阻塞中应用 　【摘要】 目的 探讨视盘放射状切开术治疗视网膜中央静脉阻塞（CRVO）的手术效果及其并发症。方法 选择20例20眼，视力0.1或以下的视网膜中央静脉阻塞患者，病程15天~3个月，平均1.8个月。其中8例有高血压史，10例患有严重的黄斑囊样水肿。术前给患者均行眼底照相、荧光素钠血管造影等检查，证实为缺血性CRVO。手术常规做睫状体平坦部巩膜三切口，先行玻璃体切割术，应用显微玻璃体视网膜切开刀，以鼻侧视乳头边缘为中心，在无血管区垂直刺入约2.2 mm深度，略向巩膜环上下微移动，避免损伤视网膜中央动静脉。结果 术后随访3~6个月，术后1个月内，所有患者视网膜或黄斑水肿减轻或消退，术后3个月眼底出血吸收，视乳头黄斑水肿消退，20侧视力均较术前提高2~8行，8例视力达0.8以上，2例为1.0。无并发症。结论 视盘放射状切开术是目前治疗CRVO有效、安全、可选择的治疗方法。 【关键词】 视网膜静脉闭塞；视盘；眼外科手术 Radial optic neurotomy for central retinal vein occlusion ［Abstract］ Objective To investigate the surgical effect and complication of optic neurotomy for ischemic central retinal vein occlusion（CRVO）.Methods Twenty patients were selected to undergo optic neurotomy，whose preoperative visual acuity was 0.1 or below.The duration of the CRVO was 15 days~3 months.The age ranged from 42 to 69 years.Seven of the 20 were men and 13 were women.Systemic hypertension was present in 8 patients and severe cystoid macular edema was present in 10 patients.No diabetes mellitus was noted in all 20 patients.A standard three port pars planar vitrectomy was performed on 20 patients with severe ischemic CRVO.A microvitreoretinal（MVR）blade was used to.Perform RON.down-up the sclera ring and adjacent sclera of the optic disk.A single cut was made on the nasal aspect of the optic disc to avoid damage to the major nasal retinal vessels.The depth of the incision into the optic nerve placed the MVR blade just beyond the widest portion shaped tip.The depth of the incision was 2.2 mm approximately.Results Optic neurotomy was performed in all 20 patients successfully，any operative complication was not noted.The following up was 3~6 months.1 month after operation,all patients had improvement in the retina and macular edema and the appearance of the fundus as documented by photography.Postoperative visual acuities were improved in all operative patients，the visual acutities was 0.8 in 8 patients and 1.0 in 2 patients.Conclusion Optic neurotomy may improve the intraretia