網膜剝離之治療　Ⅰ網膜電氣凝固術對於網膜剝離之治療之效果

Treatment of Retinal Detachment Ⅰ. The Effect of Electrocoagulation on Retinal Detachment

楊燕飛(Yen-Fei Yang) ； 柯良時(Liang-Shi Ko)

《中華民國眼科醫學會會刊》 1卷 (1962/10) Pp. 3-14

https://doi.org/10.30048/ACTASOS.196210.0001

並列摘要

Since Gonin announced for the first time in 1916 that the principle of the treatment of retinal detachment should be the complete sealing of retinal tear, the cure rate of the disease has been greatly increased (to 70%).
Many modified methods have been reported-thereafter, and as yet this principle has never been changed. Recently, some authors have emphasized the importance of scleral (lamellar) resection operation and further advocated that this should be the first choice for the operation of retinal detachment. However, this has caused serious arguments concerning the selection of operation methods in this disease.
The 79 cases presented in this paper were operated on by the method of diathermy cauterization (Weve's method) from 1951 to 1960.
Operations were carried out by senior staff as well as resident staff at our department.
1) The operations accounts for .68% of success.
2) The prognosis for the ”cases with demonstrable tear” found on the retina appears to be better (74% success) than those without tear (55%). Based on this fact, we therefore emphasize the importance in finding tear in the retinal detachment surgery. And so the authors will agree with Gonin's principle.
3) In the cases• where preoperative retinal settling was good, the success rate was statistically higher (84%) than that of the poor cases (D/SFD=＞3). Therefore, preoperative retinal settling could be an important indicator in the judgement of the prognosis of the disease.
4) Although flat detachment was generally much better in prognosis (83%. success) than cystic one, good results were still obtained (70%) in the cystic detachment with good preoperative retinal settling. This indicates that the condition of retinal detachment before the operation is not necessarily an essential factor as the preoperative retinal settling.
5) In the cases with either medial opacity or nystagmus in which a detail examination of the fundus is not possibie, the prognosis was much worse (32%) as compare with the group with clear fundus (80%). The difference between these two groups was statistically significant which indicates the necessity of detail examination of the fundus.
6) The cases with cicatricial contraction on the retina, possibly caused by excessive cauterization, showed unfavorable prognosis (only 22% success). On the other hand, those with mild pigmentation which might be caused by slight cauterization had better pregnosis (53% succes). This means that slight cauterization is preferable to excessive cauterization in the operation. In other words the strength of electric current for diathermy should be slightly weaker in order to obtain a good result.
7) In almost all recurrent cases with only one exception, some significant finding of redetachment in the fundus were observed within 2 months after becoming ambulatory. Therefore we agree with Arruga’s opinion that if the good retinal condition can be maintained for more than 2 months after becoming ambulatory be considered as a complete cure.
8) 67% of the total cases operated upon within 1 month after the onset of the disease resulted in cure. On the other hand, 86% of the cases operated upon more than 6 months after the onset resulted in cure. Therefore, the duration of the disease is not an important factor in influencing the result of operation.
9) The vision generally improved after the operation. In successful cases, the number of cases with the vision below 0.1 highly decreased from 83% preoperatively to 44% poet operatively. All cases operated on within 1 month after the onset showed improvement of vision, of these 67% had marked improvement. This group showed even further improvement in vision after discharge from the hospital by a long term follow-up examination. However, those who operated on more than 6 months after the onset did not show improvement of vision.
10) The visual field was also generally enlarged after the operation. This phenommen was particularly noticed in the successful group. The visual field of white isopter recovered to almost normal width in 96% of the cases and the visual field of blue isopter to normal range in 72%.
By a long term follow-up examination, the visual fields both for white and blue isopter were found to be more improved after discharge.
Summery: Under the following condition:
(1) when tear detectable on the retina,
(2) when the retinal detachment proved to be less severe,
(3) when preoperative retinal redeposition found to be good, and
(4) when no organic change is present to prevent proper fundus-examination, the authors would advocate the early operation in order to achieve favorable restoration of retinal functions. The operation with diathermy cauterization is the method of choice, which shoud have few complications. During operation, great precaution should be taken in the strength of galvanocurrent to avoid excessive cauterization.