脉络膜上腔注射透明质酸钠垫压手术治疗单纯性孔源性视网膜脱离12例

摘要

目的 观察脉络膜上腔注射透明质酸钠垫压手术治疗单纯性孔源性视网膜脱离(RRD)患眼的视网膜复位情况.方法 2018年10月至2019年2月在四川大学华西医院眼科经眼部B型超声、双目间接检眼镜、OCT及扫描激光检眼镜检查确诊为单纯性RRD的12例患者12只眼纳入研究.其中,男性7例,女性5例.年龄15～66岁,平均年龄(32.40±14.81)岁.BCVA＜0.1、0.1～0.4、＞0.4各4只眼.视网膜脱离范围累及1～4个象限.所有患眼均在广域显微镜带内照明系统辅助下行脉络膜上腔注射透明质酸钠垫压手术.手术均由同一位具有丰富手术经验的医师完成.手术中联合巩膜外冷冻和激光光凝封闭裂孔.手术后随访2个月,观察患眼视网膜复位情况.结果 12只眼中,视网膜完全复位6只眼(50.00％),部分复位伴黄斑区视网膜下液4只眼(33.33％),未复位2只眼(16.67％).视网膜部分复位伴黄斑区视网膜下液的4只眼,原裂孔均位于脉络膜垫压嵴上,裂孔封闭;给予密切随访,视网膜下液随时间延长逐渐吸收.视网膜未复位的2只眼采用玻璃体切割联合硅油填充手术或巩膜外硅胶垫压手术复位视网膜.所有患眼均未出现医源性视网膜裂孔、脉络膜上腔出血等手术并发症.结论 脉络膜上腔注射透明质酸钠垫压手术治疗单纯性RRD安全有效,可促进视网膜复位.%Objective To observe the retinal reattachment of suprachoroidal injection with sodium hyaluronate in the treatment of rhegmatogenous retinal detachment (RRD).Methods Twelve eyes of 12 patients with RRD diagnosed by the examinations of B-mode ultrasound,binocular indirect ophthalmoscope,OCT and scanning laser ophthalmoscope in West China Hospital of Sichuan University from October 2018 to February 2019 were included in this study.There were 7 males and 5 females,aged from 15 to 66 years,with the mean age of 32.40± 14.81 years.There were 4 eyes with BCVA＜0.1,4 eyes with BCVA 0.1-0.4,4 eyes with BCVA＞0.4.The extent of retinal detachment involves 1 to 4 quadrants.All eyes were injected with sodium hyaluronate via suprachoroidal space under non-contact wide-angle system.Surgery was performed by the same ophthalmologist with extensive surgical experience.During the operation,the retinal hole was handled with scleral freezing and laser photocoagulation.The follow-up was 2 months.The retinal reattachment was observed.Results Of the 12 eyes,6 eyes (50.00％) were anatomically reattached,4 eyes (33.33％) ere partly anatomically reattached with subretinal fluid,2 eyes (16.67％) were not reattached.The holes in 4 eyes of partly anatomically reattached with subretinal fluid were located on the choroidal pad and the holes were closed,in addition,the subretinal fluid gradually absorbed over time.Two eyes failed in retinal reattachment received vitrectomy with silicone oil tamponade or sclera buckling surgery.No severe complications such as endophthalmitis and choroidal hemorrhage were found at follow-up visits.Conclusion Suprachoroidal injection of sodium hyaluronate is an effective and safe treatment for RRD,which can promote retinal reattachment.