巩膜外加压术与23G玻璃体切除术治疗上方球形孔源性视网膜脱离的对比研究

发布时间：2018-08-19 14:16

【摘要】：目的；对比观察巩膜外加压联合玻璃体腔注气术与23G经结膜无缝合玻璃体切除联合C3F8气体填充术治疗上方球形孔源性视网膜脱离的手术效果。方法：连续收集2010年7月-2012年1月上方球形孔源性视网膜脱离病例43例,随机分为巩膜外加压联合玻璃体腔注气术组(SB组)23例,23G经结膜无缝合玻璃体切除组(23G-TSV组)20例。所有手术由同一医师完成。术后对比观察视网膜解剖复位率、视力、角膜屈光状态变化、患者舒适度、手术并发症等。结果：一次手术视网膜解剖复位率SB组为95.7%,23G-TSV组为100%,最终手术复位率两组均为100%。一次手术视网膜复位率及最终手术复位率两组间差异均无统计学意义(P均0.05)。SB组与23G-TSV组术前最佳矫正视力差别无统计学意义(P0.05),术后1周时SB组视力好于23G-TSV组,差别有统计学意义(P0.05),术后2周、1月、2月及3月时两组间最佳矫正视力差别无统计学意义(P均0.05)。术后1周、1月及2月时SB组模拟角膜曲率Sim K值均大于23G-TSV组,差别有统计学意义(P均0.05),术后3月时两组比较差别无统计学意义(P0.05)。术后1周、1月、2月及3月时SB组角膜散光度(Sim K1-K2)均大于23G-TSV组,有统计学意义(P均0.05)。SB组术后1天、3天、1周及2周为保持体位所带来的不适感明显轻于23G-TSV组(P均0.05)。术后1月及3月时两组体位不适感的比较差异无统计学意义(P均0.05)。SB组术后1天、3天、1周及2周时术眼疼痛、流泪及异物感等症状均重于23G-TSV组,差别有统计学意义(P均0.05),术后1月及3月时两组术眼疼痛、流泪及异物感等不适症状的比较差别无统计学意义(P均0.05)。SB组并发性白内障、一过性高眼压发生率均低于23G-TSV组,差别有统计学意义(P均0.05),黄斑下积液发生率高于23G-TSV组,差别有统计学意义(P〈0.05)。结论：两种手术方式均可有效治疗上方球形孔源性视网膜脱离。两种术式在视网膜解剖复位率、术后最佳矫正视力方面无明显差异。巩膜外加压术具有术后早期体位不适感轻,一过性高眼压发生率低,不会引起并发性白内障等优点。236玻璃体切除术具有对角膜屈光状态影响小,术后早期眼疼、流泪及异物感等不适症状轻,黄斑下积液发生率低等优点。
[Abstract]:Objective: to compare the effects of scleral compression combined with vitreous gas injection and 23 G vitrectomy without suture through conjunctiva combined with C3F8 gas implantation in the treatment of superior rhegmatogenous retinal detachment. Methods: 43 cases of spherical rhegmatogenous retinal detachment were collected from July 2010 to January 2012. They were randomly divided into two groups: 23 cases were treated with scleral compression combined with vitreous injection (SB group) and 20 cases were treated with vitrectomy without suture through conjunctiva (23G-TSV group). All operations are performed by the same physician. Postoperative anatomic reattachment rate, visual acuity, corneal refractive state, patient comfort, surgical complications and so on were observed. Results: the anatomic reattachment rate of retina in group SB was 95.7and 23G-TSV was 100 and that in group SB was 100. There was no significant difference in retinal reattachment rate and final reattachment rate between the two groups (P 0.05). There was no significant difference in preoperative best corrected visual acuity between SB group and 23G-TSV group (P0.05). The visual acuity of SB group was better than that of 23G-TSV group at 1 week after operation (P0.05). The difference was statistically significant (P0.05). There was no significant difference in the best corrected visual acuity between the two groups at 2 weeks, 1 month, 2 months and 3 months after operation (P 0.05). At 1 week, 1 month and 2 months after operation, the Sim K value of simulated corneal curvature in SB group was significantly higher than that in 23G-TSV group (P 0.05), but there was no significant difference between the two groups at 3 months after operation (P0.05). The corneal astigmatism (Sim K1-K2) in SB group was significantly higher than that in 23G-TSV group at 1 week, 1 month, 2 months and 3 months after operation, which was significantly higher than that in 23G-TSV group (P < 0. 05). The discomfort caused by maintaining postural position in SB group was significantly less than that in 23G-TSV group (P 0. 05). There was no significant difference in postural discomfort between the two groups at 1 month and 3 months postoperatively (P 0.05). The postoperative eye pain, tears and foreign body sensation in SB group were more serious than those in 23G-TSV group. There was no significant difference in postoperative pain, tears and foreign body sensation between the two groups at 1 month and 3 months after operation (P 0.05). The incidence of transient high IOP in SB group was lower than that in 23G-TSV group. The incidence of submacular effusion was higher than that of 23G-TSV group (P < 0. 05). Conclusion: both methods are effective in the treatment of superior spherical rhegmatogenous retinal detachment. There was no significant difference in the rate of retinal anatomical reattachment and the best corrected visual acuity between the two operations. Scleral compression has the advantages of mild postural discomfort, low incidence of transient high intraocular pressure, no complicated cataract, etc .236 vitrectomy has little effect on corneal refractive state and early postoperative eye pain. The symptoms of tears and foreign body sensation are mild and the incidence of submacular effusion is low.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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