[The efficiency of 23 G vitrectomy combined with preoperative subtenon injection of triamcinolone acetonide for treatment of retinal detachment associated with choroidal detachment].

Objective: To evaluate the efficiency of 23 G vitrectomy combined with preoperative subtenon injecfion of triamcinolone acetonide for treatment of rhegmatogenous retinal detachment associated with choroidal detachment. Methods: A retrospective analysis. Forty-eight (16 males and 32 females, aged 57.3±13.9) consecutive patients (48 eyes) who were diagnosed with rhegmatogenous retinal detachment associated with choroidal detachment and received 23 G vitrectomy at the Eye Hospital of Wenzhou Medical University during January 2012 and January 2015 were enrolled. Twenty-three eyes were treated with subtenon injection TA 5 d before the planned 23 G vitrectomy (TA group). Twenty-five eyes were treated with dexamethasone 3 to 5 d before the planned vitrectomy (Dex group). Type-B ultrasonic, intraocular pressure, best corrected visual acuity examinations were conducted for all eyes on admission day, preoperatively and at 1 month, 3 month postoperatively, and during the last visit. The rate of reattachment, change of height of choroidal detachment, intraocular pressure, best corrected visual acuity, and the complication of the eyes between the two groups were compared. All patients were followed up at least half a year after the repair surgery. Results: The intraocular pressure of the TA group was higher than the Dex group[(8.58±3.83)mmHg vs. (6.70±2.49)mmHg (1 mmHg=0.133 kPa), (t=2.032)], and the height of choroidal detachment was lower in TA group [0.90(0.00, 3.84)mm vs. 4.03(1.05, 5.38)mm, Z=-2.569, P<0.05]. There is no statistic difference between the reattachment rate of the two groups [95.7%(22/23) vs. 76.0%(19/25), χ(2)=2.304, P=0.129], but it seems it was better in TA group. The best corrected visual acuity results of the last visit was better in TA group than Dex group [(0.91±0.54) vs. (1.25±0.62), t=-2.034, P=0.048]. The rate of hypertention was higher in TA group than Dex group at 1 month, 3 month postoperatively(χ(2)=2.304, 5.648, P<0.05), while there was no statistic difference of hypertention rate during last visit between the two groups (χ(2)=0.006, P=0.941). Conclusions: The treatment of 23 G vitrectomy combined with subtenon injection of triamcinolone acetonide can improve the intraocular pressure, reduce the height of choroidal detachment, and improve the best corrected visual acuity after the surgery, but it may cause heyertenion. (Chin J Ophthalmol, 2018, 54: 252-257).目的： 探讨后Tenon囊下注射曲安奈德后行23 G玻璃体切除术治疗脉络膜脱离型视网膜脱离的疗效。 方法： 回顾性病例对照研究。收集2012年1月至2015年1月在温州医科大学附属眼视光医院确诊为脉络膜脱离型视网膜脱离并接受23 G玻璃体切除术治疗的连续性病例48例（48只眼），其中男性16例（16只眼），女性32例（32只眼），平均年龄为（57.3±13.9）岁。23只眼术前后Tenon囊下注射曲安奈德（曲安奈德组），25只眼术前静脉滴注地塞米松10 mg/d（地塞米松组）。所有患者入院时、手术当天、术后1和3个月、末次随访均行B超、眼压、最佳矫正视力等检查，比较两组患者术前眼压、脉络膜脱离高度变化及手术复位率、视力改善情况、眼部并发症等，术后随访时间≥6个月。患者术前视力采用单因素方差分析进行比较，其余正态分布的计数资料采用t检验；计数资料采用卡方检验。 结果： 玻璃体切除术前，曲安奈德组和地塞米松组眼压分别为（8.58±3.83）和（6.70±2.49）mmHg（1 mmHg=0.133 kPa）（t=2.032），脉络膜脱离高度分别为0.90（0.00，3.84）和4.03（1.05，5.38）mm（Z=-2.569），差异均有统计学意义（P<0.05）。曲安奈德组患者手术复位率为95.7%（22/23），与地塞米松组的76.0%（19/25）相比，差异无统计学意义（χ(2)=2.304，P=0.129）。末次随访时曲安奈德组视力为0.91±0.54，优于地塞米松组的1.25±0.62（t=-2.034，P=0.048）。术后1和3个月时，曲安奈德组高眼压发生率较高（χ(2)=2.304，5.648；P<0.05），末次随访时差异无统计学意义（χ(2)=0.006，P=0.941）。 结论： 后Tenon囊下注射曲安奈德可提高眼压，降低脉络膜脱离高度，改善脉络膜脱离型视网膜脱离患者23 G玻璃体切除术后的视力预后，但可能会引起术后高眼压。（中华眼科杂志，2018，54：252-257）.