联合手术保留环形前囊膜治疗孔源性视网膜脱离合并白内障的疗效观察

发布时间：2018-11-24 08:59

【摘要】：目的:比较玻璃体切割(Pars plana vitrectomy,PPV)联合白内障超声乳化吸出手术中保留晶状体环形前囊膜和后囊膜治疗孔源性视网膜脱离(Rhegmatogenous retinal detachment,RRD)合并年龄相关性白内障的疗效差异。方法:回顾性分析2014年12月至2016年6月在广西壮族自治区人民医院眼科确诊为RRD合并年龄相关性白内障并行23G玻璃体切割、硅油填充联合白内障超声乳化吸出手术治疗的58例患者58眼的病例资料。其中,A组28只眼,保留晶状体环形前囊膜;B组30只眼,保留晶状体后囊膜。所有患眼术后3~4个月均行玻璃体腔硅油取出联合人工晶状体二期植入手术。对比分析手术前及手术后两组患者的视网膜复位率、最佳矫正视力(Best corrected visual acuity,BCVA)、玻璃体腔硅油取出联合人工晶状体二期植入手术时间及手术并发症的差异。所有患者玻璃体腔硅油取出联合人工晶状体二期植入手术后至少随访3个月。结果:(1)保留晶状体环形前囊膜组和保留晶状体后囊膜组的术后一次性视网膜复位率分别为89.28%和86.66%,两组患者术后一次性视网膜复位率差异无统计学意义(P0.05)。(2)两组患者末次随访的最小分辨角对数(log MAR)BCVA与术前比较差异均有统计学意(P0.05),两组术后logMAR BCVA均好于术前。两组患者末次随访的logMAR BCVA比较差异无统计学意义(P0.05);两组患者术后视力提高率相比差异无统计学意义(P0.05);两组患者术后脱盲率相比差异有统计学意义(P0.05),保留环形前囊膜组术后脱盲率优于保留后囊膜组。(3)两组患者行玻璃体腔硅油取出联合人工晶状体二期植入手术的手术时间比较,差异有统计学意义(P0.05),保留环形前囊膜组手术时间短于保留后囊膜组。(4)两组患者术后复发性视网膜脱离、早期高眼压、角膜水肿、角膜上皮缺损、前房渗出和前房积血的发生率比较,差异均无统计学差异(P0.05)。此外,保留晶状体后囊膜组术后出现6例后囊浑浊(Posterior capsule opacification,PCO),予Nd:YAG激光晶状体后囊切开术治疗后BCVA改善。结论:PPV联合白内障超声乳化吸出手术中保留晶状体环形前囊膜可在保证RRD合并年龄相关性白内障治疗效果的同时,提高患者术后的脱盲率,有效预防PCO并缩短玻璃体腔硅油取出联合人工晶状体二期植入手术的时间。
[Abstract]:Objective: to compare the effects of vitrectomy (Pars plana vitrectomy,PPV) combined with phacoemulsification in the treatment of rhegmatogenous retinal detachment (Rhegmatogenous retinal detachment,) by reserving the annular anterior capsule of lens and posterior capsule in the treatment of rhegmatogenous retinal detachment. RRD) and age-related cataract. Methods: from December 2014 to June 2016, the diagnosis of RRD with age-related cataract and 23 G vitrectomy in ophthalmology of Guangxi Zhuang Autonomous region people's Hospital were retrospectively analyzed. Data of 58 eyes of 58 patients with phacoemulsification combined with silicone oil filling and phacoemulsification. In group A, the annular anterior capsule was preserved in 28 eyes, and in group B, the posterior capsule was preserved in 30 eyes. Vitreous silicone oil extraction combined with IOL implantation was performed in all eyes 3 ~ 4 months after operation. The retinal reattachment rate, best corrected visual acuity (Best corrected visual acuity,BCVA), vitreous silicone oil extraction and intraocular lens implantation were compared between the two groups before and after surgery. All patients were followed up for at least 3 months after vitreous silicone oil extraction and intraocular lens implantation. Results: (1) the one-off retinal reattachment rates were 89.28% and 86.66% in the anterior capsule group and the posterior capsule group, respectively. There was no significant difference in the rate of retinal reattachment between the two groups (P0.05). (2). The lognormal resolution angle (log MAR) BCVA) of the last follow-up in the two groups was significantly different from that before the operation (P0.05). LogMAR BCVA in both groups was better than that before operation. There was no significant difference in logMAR BCVA between the two groups at the last follow-up (P0.05), and there was no significant difference in the rate of postoperative visual acuity between the two groups (P0.05). There was significant difference between the two groups (P0.05). (3) the two groups of patients with vitreous silicone oil extraction combined with intraocular lens implantation operation time comparison, the difference was statistically significant (P0.05). (4) the incidence of recurrent retinal detachment, early intraocular pressure, corneal edema, corneal epithelial defect, anterior chamber exudation and hyphema were significantly shorter in the annular anterior capsule group than in the posterior capsule preservation group. (4) the incidence of recurrent retinal detachment, early intraocular hypertension, corneal edema, corneal epithelial defect, anterior chamber exudation and hyphema were compared between the two groups. The differences were not statistically significant (P0.05). In addition, there were 6 cases of posterior capsular opacification (Posterior capsule opacification,PCO) in the posterior capsule group. BCVA was improved after Nd:YAG laser posterior capsulorotomy. Conclusion: PPV combined with phacoemulsification can keep the annular anterior capsule of the lens in the phacoemulsification surgery to ensure the effect of RRD combined with age-related cataract at the same time to improve the rate of blindness reduction after operation. To prevent PCO and shorten the time of vitreous silicone oil extraction combined with IOL implantation.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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