The Clinical Study Of Surgery For Bullous Rhegmatogenous Retinal Detachment

Objective To investigate the effect of the improved drain-air-cryo-therapy-explants (DACE) operation method for bullous rhegmatogenous retinal detachment(BRRD).Methods The cases of 38 eyes in 38 patients with bullous rhegmatogenous retinal detachment who underwent surgery for the first time in our hospital from 2007.10 to 2008.8 were reviewed retrospectively.Experimental group(Improved DACE) enrolled 22 cases(22 eyes) and control group(routine scleral buckling procedure) enrolled 16 cases(16 eyes).Surgical techniques:In the Experimental Group,preset the suture to guide the rectus first and carry out the drainage and air injection,then pour gas with the 20-25mmHg air pressure via vitrina ocularis equipment.Then align hole/tear under the binocular indirect ophthalmoscope cryotherapy out of the albuginea oculi and suture the wheel-gel-silica-pressure parallel the limbus corneae or suture radiately or use united cerclage.In the Control Group,preset suture to guide the rectus and align hole/tear under the binocular indirect ophthalmoscope cryotherapy out of the albuginea oculitus first,then draw off the liquid and suture the wheel- gel- silica-pressure parallel the limbus corneae or suture radiately or use united cerclage.After the operation,whether to influx gas or not depended on the patients'different conditions.The two groups supplied with reverse trendelenburg position or lateral decubitus was according to the hole/tear position.Added photo-coagulation when it was necessary.Follow-up 3-6months,the average time was 4.12±3.56 months.All the factors were observed with SPSS13.0 statistical package.Results All the cases operated successfully.The ratio of the final reattachment and the replacement of the one-time operation:the Experimental Group(improved DACE) was 90.9%(20/22) and 100.0%(22/22).the Control Group(routine scleral buckling procedure) was87.5%(14/16)and 93.8%(15/16), the distinction has no statistical significance(P=1.000 and P=0.421);The accurate ratio of hole/tear location:the Experimental Group was 95.5%(21/22), the Control Group was 62.5%(10/16),the distinction has statistical significance(P=0.028);The advanced ratio of the best corrected vision after the surgery:the Experimental Group was 77.3%(17/22),the Control Group was 56.3%(9/16),the distinction has no statistical significance(P=0.421);The postperative complications:new hole/tear and cataract in the Experimental Group exceeded the Control Group,however,the retina reductus and PVR advancement were lower than the Control Group,the incidence rate distinction has no statistical significance(P>0.05).Conclusions The improved DACE technique is a kind of safe and effective method to treat rhegmatogenous retinal detachment(BRRD),with the characteristic of stable intraocular tension during the operation, exact hole/tear location,precise cryotherapy and etc.