於複雜性視網膜剝離之玻璃體切除術合併使用鞏膜收縮術：初報

Scleral Shortening Combined with Vitrectomy in the Treatment of Complicated Retinal Detachment: Initial Experience

郭瑜良(Yu-Liang Kuo) ； 劉寬鎔(Kwan-Rong Liu)

《中華民國眼科醫學會雜誌》 34卷4期 (1995/12) Pp. 495-501

https://doi.org/10.30048/ACTASOS.199512.0009

摘要

複雜性視網膜剝離如增殖性糖尿病視網膜病變(PDR)或增殖性玻璃體視網膜病變(PVR)等，因有很強之牽引力量及增殖膜，常需施行玻璃體切除術才能使網膜復位。而術中有時過到視網膜收縮變短(retinal shortening)、裂孔的出現，以及無法完全剝除(peeling)的增殖膜等狀況，以致即使做了氣體填塞術(air tamponade)後仍無法使網膜復位。此時合併使用鞏膜收縮術可縮減鞏膜表面積而使網膜表面積縮減之情形緩解，並能緩除牽引及裂孔因素提高網膜復位的成功率。我們自4年前開始試用此法，以電燒造成鞏膜表面凝縮(surface coagulation)來達到鞏膜表面積縮減之效果，發現簡單迅速且成效不錯，可避免傳統上施行鬆弛性視網膜切開街(relaxing retinotomy)之諸多併發症，又無一般電燒易發生之鞏膜壞死。今提出此法及10例報告。其中七例成功復位，視力皆能穩定或進步，追綜期間自6個月至3.5年，無特殊之併發症出現。

並列摘要

Retinal shortening is sometimes noted during the vitrectomy for complicated retinal detachment of PDR or PVR. Because of disproportional surface area between retina and choroid-RPE layer, retinal shortening cant be overcome with intraocular tamponade. Methods for reducing unequal surface area such as scleral shortening or relaxing retinotomy must be used for further retinal reattachment.
Diathermic scleral shortening is developed for this problem. After complete membrane peeling and air-fluid exchange, retinal shortening is proved as a ”tenting” retina. We use diathermic surface coagulation to shorten the sclera subsequently. Diathermic surface coagulation is achieved when the energy of wet-field bipolar-is adjusted to the point, which causes scleral shrinkage without ”yellowish” color change. It must be applied over a well-rinsed scleral surface without episcleral tissue. The diathermic patches are scattered over the area of retinal shortening without overlapping to avoid over- diathermy. Finally, intraocular tamponade is given for retinal reattachment. It takes only several minutes to perform this procedure.
Among 10 cases received this procedure, 7 cases got reattachment with stationary or improved visual acuity. Follow up periods range from 6 months to 3.5 years. No major complications are noted. It seems that diathermic scleral shortening is a quick, safe, easy and effective method compared with traditional scleral shortening and relaxing retinotomy.

並列關鍵字

scleral shortening ； surface coagulation ； intraocular tamponade ； relaxing retinotomy