【摘要】 目的 观察视网膜裂孔和视网膜脱离伴玻璃体积血的治疗效果。方法 回顾性分析应用双眼遮盖、激光光凝及手术治疗视网膜裂孔和视网膜脱离伴玻璃体积43例（43眼）血病人的临床资料。结果 经双眼遮盖治疗1～14 d（平均4.6 d），眼底可视度增加。其中24眼行激光光凝封闭视网膜裂孔,4眼行局部巩膜外垫压术,术后视网膜复位，裂孔封闭，无再出血。15眼行三通道闭合式玻璃体切除术，术后视网膜脱离复发1例。结论 视网膜裂孔和视网膜脱离伴玻璃体积血时，双眼遮盖并及时行激光光凝封闭视网膜裂孔以及早期手术是争取较好视力预后的关键。
【关键词】 视网膜穿孔；视网膜脱离；玻璃体出血；激光凝固术；玻璃体切除术
MANAGEMENT OF RETINAL TEARS AND RETINAL DETACHMENT ACCOMPANY WITH VITREOUS HEMORRHAGEMENG XUXIA, LIANG TAO, CUI CONGXIAN (Department of Ophthalmology, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China） ［ABSTRACT］ObjectiveTo investigate the therapeutic effects of retinal tears and retinal detachment with vitreous hemorrhage.MethodsA retrospective survey was done in 43 patients (43 eye) with retinal tears and retinal detachment with vitreous hemorrhage who underwent ambulatory binocular occlusion, laser photocoagulation, or operation. They were followed up for 6 to 22 months. ResultsApplying ambulatory binocular occlusion for average 4.6 days resulted in clearing of the vitreous to allow the tears examined, of the 43 eyes, 24 eyes were treated with laser photocoagulation, four were treated with scleral buckling surgery. Retinal reattachment was achieved and vitreous hemorrhage did not recur, 15 eyes treated with a pars plana vitrectomy and successfully reattached, redetachment recurred in one eye.ConclusionIn the cases of retinal tears and retinal detachment with vitreous hemorrhage, prompt laser photocoagulation and operation is recommended.
［KEY WORDS］retinal perforations; retinal detachment; vitreous hemorrhage; laser coagulation; vitrectomy
孔源性视网膜脱离和视网膜裂孔伴有玻璃体积血时，由于屈光间质混浊，往往影响眼底检查，易忽略并遗漏视网膜裂孔和视网膜脱离的诊断，从而延误视网膜脱离的治疗。如何早期发现视网膜裂孔和视网膜脱离，积极采取合理的治疗是获得较好视力的关键。2001年1月～2005年12月，我院治疗此类病例43例，现报告如下。
1 资料和方法
1.1 一般资料
在我院眼科检查确诊为视网膜裂孔和孔源性视网膜脱离伴玻璃体积血病人43例（43眼），其中男23例，女20例；年龄19～76岁，平均42.7岁。右眼22例，左眼21例。视力：手动～指数者11例、0.02～0.05者18例、0.06～0.1者12例、0.2～0.3者2例；均无眼外伤史，无明显高血压及糖尿病病史，排除静脉周围炎。其中15例15眼近视度数为-2.00～-8.00 D。43例病人均主诉视力突然下降，时间为1～7 d，平均3.5 d。所有病人均经双眼充分散瞳后裂隙灯、双目立体检验镜及B型超声检查。眼底检查不充分，眼底像不清29眼，眼底完全无法窥见14眼。眼部B型超声检查，除玻璃体混浊外，35例35眼有玻璃体后脱离，视网膜脱离22眼。43例病人的视网膜裂孔均位于视网膜周边部，即赤道及赤道部以前。无视网膜脱离的视网膜裂孔21例，占48.84%；有视网膜脱离的视网膜裂孔22例，占51.16%。
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