巩膜扣带术后影响视网膜复位和视力恢复的相关因素分析

发布时间：2018-06-21 22:24

本文选题：孔源性视网膜脱离 + 巩膜扣带术　；参考：《眼科新进展》2017年02期

【摘要】：目的分析孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)行巩膜扣带术后影响视网膜复位和视力恢复的相关因素,为临床治疗提供参考。方法回顾性临床研究,选择2012年1月至2016年1月我院收治的初发RRD患者行巩膜扣带术治疗者148例148眼,观察术后视网膜解剖复位率、最佳矫正视力(best-corrected visual acuity,BCVA)及并发症,并对可能影响术后视网膜复位和视力恢复的相关因素进行Logistic回归分析。结果检眼镜和眼底照相检查示首次手术视网膜复位率为91.9%,最终复位率为97.3%;频域光学相干断层扫描(spectral-domain optical coherence tomography,SD-OCT)检查视网膜首次复位率为60.1%,最终复位率为80.4%。单因素Logistic回归分析结果表明:多发视网膜裂孔和C1级增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)对视网膜复位率有显著影响(均为P0.05);单因素Logistic回归分析结果显示:术前BCVA、病程长短、视网膜脱离范围、黄斑累及与否对术后BCVA恢复均有明显影响(均为P0.05),而年龄、术前屈光状态、PVR分级、术中是否实施视网膜下放液、玻璃体内注气、联合巩膜外加压、术后视网膜下液对术后BCVA的恢复均无明显影响(均为P0.05);多因素Logistic回归分析结果显示:术前BCVA是影响术后BCVA的独立危险因素(P0.05)。结论巩膜扣带术治疗RRD效果良好,但多发视网膜裂孔和C1级PVR会增加手术失败风险;术前视力、病程长短、视网膜脱离范围、黄斑状态均影响巩膜扣带术后视力的恢复,而术前视力是关键因素,提示RRD患者应早发现、早治疗,尽可能保护术前视力。
[Abstract]:Objective to analyze the factors related to retinal reposition and visual acuity recovery after scleral buckling (rhegmatogenous retinal detachment, RRD), and to provide reference for clinical treatment. Methods Retrospective clinical study was conducted, and 148 cases of primary RRD patients treated in our hospital from January 2012 to January 2016 were treated with scleral buckling, and 1 cases were treated with scleral buckling. 48 eyes, the retinal anatomic reduction rate, the best corrected visual acuity (best-corrected visual acuity, BCVA) and complications were observed after the operation, and the related factors that might affect the retinal reposition and visual recovery after operation were analyzed by Logistic regression. Results the retinal reposition rate of the first operation was 91.9% and the final reduction rate was shown by the examination of ophthalmoscope and fundus photography. For 97.3%, the frequency domain optical coherence tomography (spectral-domain optical coherence tomography, SD-OCT) examined the initial retinal reposition rate of 60.1% and the final reduction rate of 80.4%. single factor Logistic regression analysis showed that multiple retinal holes and C1 grade proliferative vitreous retinal lesions (proliferative vitreoretinopathy, PVR) were matched. The rate of retinal reposition was significantly affected (all P0.05). The results of single factor Logistic regression analysis showed that preoperative BCVA, the duration of the disease, the range of retinal detachment, and the macular involvement have obvious influence on the recovery of BCVA after operation (all P0.05), and the age, preoperative refraction, PVR classification, the operation of retina subsurface fluid, and the intravitreal injection of gas, In combination with external scleral pressure, subretinal fluid had no significant effect on postoperative BCVA recovery (P0.05). Multiple factor Logistic regression analysis showed that preoperative BCVA was an independent risk factor for postoperative BCVA (P0.05). Conclusion scleral buckling is good for RRD treatment, but multiple retinal holes and C1 grade PVR will increase the operation failure wind. The preoperative vision, the length of the disease, the range of retinal detachment, and the macular state all affect the recovery of visual acuity after scleral buckling, and the preoperative vision is the key factor, suggesting that the RRD patients should be found early, treated early, and protect the visual acuity as much as possible.
【作者单位】：西安交通大学医学院附属三二○一医院眼科;汉中市口腔医院正畸科;西安交通大学第一附属医院眼科;
【分类号】：R779.6

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