本视频为2025年10月于山西省眼科医院所开展的玻璃体视网膜相关院基培训的手术范例之一。
在本视频中，Hendrick医生与学员为一名右眼视网膜脱离，且左眼有过巩膜环扎术手术史的43岁男性患者，施行了右眼巩膜环扎术。
手术地点：山西省眼科医院，太原，山西省，中国
手术医生：Andrew M. Hendrick医生，埃默里大学 (Emory University)，美国
Transcript
0:00 This is a highly myopic 40 year old symptomatic from a superotemporal retinal detachment. He’d had a worsening shadow developing for the past few days. This patient is under general anesthesia due to the anticipated discomfort of this surgery.We start with a standard conjunctival peritomy and bluntly relax tenon’s fascia with blunted stevens scissors if available.
本例为一名40岁高度近视患者，因上颞部视网膜脱离出现症状。患者近几天出现逐渐加重的阴影感。考虑到手术过程可能带来的不适，患者在全身麻醉下接受手术。首先，常规行结膜环形切开，且如有条件，使用钝Stevens剪刀钝性松解Tenon囊筋膜。
1:10 Next, we isolate each of the rectus muscles with fenestrated muscle hooks with a 2-0 silk suture that will remain with and be repeated for each of the recti. I gently bluntly dissect the residual tenon’s fascia with a cotton tip to demonstrate a fairly sharp demarcation visible when you inspect the muscle insertion. Once this is done, we will inspect the retina with indirect ophthalmoscopy and apply cryopexy to surround the retinal breaks. Then we externally mark the location of the most posterior break with a marking pen. Be aware of how parallax can distort your view.
随后，采用带有2-0丝线的开窗肌钩依次分离每一条直肌，丝线留置并对每条直肌重复操作。使用棉签钝性分离残余Tenon囊筋膜，可在检查肌肉附着点时清晰显示分界。上述步骤完成后，应用间接检眼镜检查视网膜，并对视网膜裂孔周围行冷凝治疗。然后，使用记号笔在眼外标记最靠后的裂孔位置，注意视差可能引起的视野扭曲。
2:53 Viscoelastic on the cornea will keep your view as clear as possible throughout surgery. See the purple mark and now I measure to allow circumferential placement of an encircling element. I make a horizontal mattress pass with a 5-0 nylon or Mersilene, approximating 50% scleral depth, trying to keep a view of the need tip in the sclera at all times. This process is repeated in each oblique quadrant. In order to induce imbrication, I try to place my passes 1mm wider than the width of the element I chose to implant. This imbrication should close the break once these sutures are tightened. I like a bigger implant with larger breaks, or with more complex pathology. The implant should support the posterior aspect of the retinal break. Each of the sutures are initially secured with a 3 throw knot and left loose.
在角膜表面应用黏弹剂可在整个手术过程中尽量保持手术视野清晰。根据紫色标记进行定位，并进行测量，以便能够环周安放环扎物。使用5-0尼龙线或Mersilene线（聚酯纤维线）进行水平褥式缝合，缝合深度约为巩膜厚度的50%，操作过程中始终保持针尖在巩膜内可见。上述操作在每个斜象限依次重复。为诱导嵌叠，每次穿刺的间距应比所选植入物的宽度宽1毫米。当缝线收紧后，这种嵌叠能够促使裂孔闭合。对于较大的裂孔或更复杂的病理情况，建议选择更大尺寸的植入物。植入物应有效支撑视网膜裂孔的后部区域。每根缝线最初以三次打结固定，并保持松弛。
7:16 The band has the sleeve attached in this video. The band is threaded under each of the rectus muscles and through the pre-placed suture. I have an assistant gently rotating the adjacent rectus muscles and a schepen’s retractor or muscle hook can retract tenon’s tissue posteriorly.
本视频中所用的环扎带已连接有套管。环扎带依次穿过每一条直肌下方，并通过预先置入的缝线。助手协助轻柔旋转邻近的直肌，同时可使用Schepen氏拉钩或肌钩向后牵拉Tenon囊组织。
8:25 By convention, we affix the sleeve in the superonasal quadrant. At this point, we need to affix the band to itself with the sleeve. My instrument is under the sleeve, and I am able to grasp the free end of the band and pull into the sleeve. I continue to pull the slack out of the buckle to approximate its anticipated position and tension. I try to target a physiologic pressure – be careful not to overtighten. This drives the encircling belt effect to support the vitreous base and should circumferentially visibly cover the pathology when the fundus is inspected.
常规情况下，我们将套管固定于上鼻象限。此时，需要利用套管将环扎带自身固定。器械置于套管下方，可抓持环扎带的游离端并牵引至套管内。继续拉紧扣带的松弛部分，使其接近预期的位置和张力。应尽量达到生理性压力，注意避免过度紧缩。此举可产生环扎带的支撑作用，有效支持玻璃体基底，并在检查眼底时应能环形覆盖病变区域。
9:06 The ends of the band are trimmed to reduce bulk. And I secure the preplaced sutures in permanent fashion to imbricate. You can see the shortening of the sclera. This reduces vitreous volume and can elevate the intraocular pressure. I typically secure the two quadrants away from the drainage site, superior to the lateral rectus. These knots need to be rotated posteriorly to reduce potential for exposure. We – off camera – will now inspect the fundus with indirect ophthalmoscopy to ensure clear media, buckle placement, perfusion of the disc, and appropriate plan for external drainage based on the apex of the detached retina.
将环扎带两端修剪，以减少体积。随后，将预先放置的缝线永久性固定，实现组织嵌叠。可以观察到巩膜的缩短。这一步骤减少了玻璃体体积，并可能导致眼内压升高。我通常将远离引流部位的两个象限固定在外直肌上方。这些缝线结需向后旋转，以降低暴露风险。我们将在镜头外通过间接检眼镜检查眼底，以确保介质清晰、巩膜扣带位置准确、视盘灌注良好，并根据脱离视网膜的顶点合理制定外引流方案。
10:16 The assistant is gently driving the eye inferonasally and retracting the soft tissues for exposure. I hold the buckle away from my blade and incise full thickness scleral incision until eye see a dark choroidal stripe or bulge. Once it exposed well, I typically cauterize the choroid pre-emptively. Here we use a needle first and you can see the spontaneous egress of subretinal fluid. Some external hemorrhage is visible and we cauterize it.
助手轻柔地将眼球向下并向鼻侧转动，同时牵开软组织以获得充分的手术暴露。我将巩膜扣带移开刀片，进行全层巩膜切开，直至见到暗色脉络膜条带或隆起。在充分暴露后，我通常会预先对脉络膜进行电凝处理。此处我们首先使用针头，可以观察到视网膜下液自发引流。可见部分外源性出血，我们对其进行了电凝止血。
10:52 Once the subretinal fluid drainage is complete we complete securing the remaining oblique sutures to the sclera and take the slack out of the buckle as the fluid drainage has left the eye hypotonous. Once these are secure, it is a good time to complete the final inspection of the fundus and consider merits of intravitreal gas bubble injection, which I rarely opt for unless the break is residually open.
在视网膜下液引流完成后，我们继续将剩余的斜行缝线牢固固定于巩膜，同时根据引流后眼球变为低张状态，适当调整巩膜扣带的张力。缝线固定完成后，应对眼底进行最终检查，并酌情评估玻璃体腔内注气的必要性。除非视网膜裂孔仍有残余开放，否则我通常不选择进行玻璃体腔注气。
11:56 We were content with the retinal attachment and no extra steps were needed. Now the conjunctiva is closed using 7-0 vicryl, although gut may be preferable when available. Now would be the time for local anesthetic to enhance the postoperative comfort.
本例视网膜复位良好，无需额外手术步骤。随后采用7-0 Vicryl缝线闭合结膜，如有条件，亦可选用肠线以获得更佳效果。此时可进行局部麻醉，以增强患者术后舒适度。
Last Updated: June 16, 2026