患儿女性,12 岁.因7 岁时家长发现双眼视力差、畏光伴眼球震颤、习惯性揉眼,于当地医院就诊,诊断为:双眼弱视.给予散瞳验光、配镜后进行弱视训练,每半年进行复诊,发现视力仍呈下降趋势,畏光症状加重,2022 年 8 月转诊于我院.患儿既往体健,足月顺产,生长发育无异常,无外伤、手术史,智力正常.家族内无遗传疾病或相同病史.
目的 观察白内障合并不同程度晶状体悬韧带异常手术治疗的短期临床效果.方法 回顾性病例系列研究.中国人民解放军联勤保障部队第九四四医院2018年12月至2022年6月手术治疗的晶状体悬韧带异常白内障患者37例(39眼),根据晶状体悬韧带异常范围将其分为3组:A组11例(11眼)悬韧带松驰或断裂范围<60°,行超声乳化白内障吸出及人工晶状体植入术;B组22例(23眼)悬韧带断裂范围60°～150°,行超声乳化联合囊袋内张力环和人工晶状体植入术;C组4例(5眼)悬韧带断裂范围>150°,行超声乳化联合前段玻璃体切除及人工晶状体睫状沟缝线固定术.术后随访3个月,检测患者手术前后最佳矫正视力、眼压、中央前房深度和角膜内皮细胞计数,观察手术并发症.结果 A、B、C组术后各时间点最佳矫正视力均较术前提高,差异有统计学意义(FA=17.00、FB=28.58、FC=9.73,均P<0.05),但各组患者术后1个月和术后3个月视力差异无统计学意义(均P>0.05).术后1 d共有10例(10眼)眼压>21 mmHg,经1～3种降眼压药物治疗1～2周眼压均控制到正常范围.术后3个月,3组患者眼压均正常且无药物辅助.中央前房深度A组、B组术后3个月分别为(3.92±0.32)mm、(3.46±0.28)mm,较术前(2.91±0.42)mm、(2.77±0.38)mm明显加深(tA=-9.06、tB=-7.89,均P<0.05);C组术前为(2.85±0.85)mm,术后3个月为(3.20±0.09)mm,手术前后比较差异无统计学意义(P>0.05).三组患者术后3个月角膜内皮细胞计数均较术前减少(tA=13.55、tB=35.59、tC=13.95,均P<0.05).结论 白内障合并晶状体悬韧带异常患者,需根据晶状体悬韧带异常范围选择个体化手术方式治疗,可有效预防并发症发生,获得良好的视力.
Objective:To analyze the efficacy of 25 G vitrectomy with air tamponade in the treatment of rhegmatogenous retinal detachment.Methods:This was a retrospective case series study.The clinical data of 28 eyes of 28 cases with rhegmatogenous retinal detachment from Jan.2019 to Jun.2021 in the 944th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army were analyzed.All cases received 25 G vitrectomy with air tamponade.The patients were followed up for more than 3 months, and the visual acuity, postoperative retinal reduction and postoperative complications were observed.Results:The visual acuity (BCVA, logMAR) at 1 week, 1 and 3 months postoperatively were 0.69±0.46, 0.57±0.36 and 0.53±0.38, and which were better than 0.79±0.65 preoperatively ( F=7.13, P=0.037). The retinal reattachment rate at 3 months after operation was 96.43% (27/28). There were no serious complication such as infectious endophthalmitis and explosive suprachoroidal hemorrhage. Conclusion:25 G vitrectomy with sterile air tamponade is safe and effective in the treatment of rhegmatogenous retinal detachment, with good postoperative visual recovery and less complications.
