【摘要】 目的 探讨一种可调控自封闭巩膜切口排视网膜下液的可行性及手术效果。方法 在一组连续78例(79眼)简单裂孔性视网膜脱离外路显微手术中，用11号尖刀片，在要排液的部位以45°角倾斜、放射状刺入巩膜约1～2mm，形成一种用刀片压住巩膜切口下唇，视网膜下液即流出，不压下唇即封闭的巩膜切口。显微镜下观察排液孔内外口的情况。术后详细观察手术效果。结果 成功排出视网膜下液77眼(97.5%)，其中一次性排液成功73眼(92.4%)，2眼调整位置后排液成功，2眼由于眼压较低需借助皮下注射针头穿刺脉络膜排液成功。未能排除视网膜下液2眼。排液并发症有视网膜嵌顿3眼，视网膜穿孔1眼，视网膜下少量出血11眼。这些并发症经及时处理均未出现严重后遗症。一次手术成功率92.4%(73眼)。再次手术后视网膜复位4眼。最终成功率为97.5%(77眼)。术后视力：≤0.1者26眼，0.2~0.4者29眼，0.5~0.9者14眼，≥1.0者10眼，视力较术前显著提高(P<0.01)。结论 可调控自封闭巩膜切口排视网膜下液的技术具有简单、快速、安全和有效的优点。

    【关键词】 视网膜脱离；显微手术；排视网膜下液

    A controllable self-sealing sclerotomy for drainage of subretinal fluid

    LIU Wen,WANG Dan-dan,HUANG Su-ying.

    Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangzhou 510060,China

    【Abstract】 Objective To evaluate the feasibility and surgical effects of a controllable self-sealing sclerotomy for drainage of subretinal fluid(SRF).Methods 79 eyes of seventy-eight consecutive patients with rhegmatogenous retinal detachment(RD) underwent scleral buckle and external drainage of SRF with a sharp knife under the microscope.The SRF was drainaged by a technique whereby a radial scleral penetrating of 1~2mm deep was made with a sharp knife in 45 oblique angle.Thus,the outflow of SRF can be controlled.The SRF was discharged as the inferior valve of the sclerotomy was been pressing and the drainage was stopped as the pressing was relieved.The internal incisions of the drainage were examined under the microscope with the scleral indentation.The drainage effects and microsurgical reattachment rate were observed.Results The SRF was drained successfully in 77 eyes,among them,initial successful drainage was obtained in 73 eyes and the second was got in 2 eyes after changing the site of drainage.Due to lower intraocular pressure,a subdermic need was used to penetrate the choroid in remaind two eyes.The SRF was unable to be expelled in 2 eyes.The complications of drainage included retinal incaceration in 3 eyes,retinal perforation in one eye and minimum hemorrhage beneath the retina in 11 eyes.These complications were all treated in time to avoid serious sequelaes.One operation was done in 73 eyes and once more operations were needed in 6 eyes,but two patients refused resurgery for RD.SRF absorbed completely and the retinal got reattachment in 77 eyes at last.The postoperative visual acuity was level ≤0.1 in 26 eyes,0.2~0.4 in 29 eyes,0.5~0.9 in 14 eyes and ≥1.0 in 10 eyes.Conclusion The controllable self-sealing sclerotomy for drainage of subretinal fluid is a simple,quick,safe,and effective method. ......