陈旧性孔源性视网膜脱离临床相关因素及疗效研究

发布时间：2018-03-28 08:52

本文选题：视网膜脱离　切入点：陈旧性　出处：《浙江大学》2011年硕士论文

【摘要】：目的：分析陈旧性孔源性视网膜脱离的临床相关因素以及手术治疗效果。设计：回顾性病例对照研究。对象：我院自2008年6月至2010年11月视网膜病组所收治入院的同一术者连续103例(103眼)原发性RRD患者。入选标准：有症状的原发性视网膜脱离,直接或间接眼底镜下明确视网膜裂孔和视网膜脱离范围超过赤道后2DD以上。排除标准：继发性视网膜脱离(如渗出性、牵引性及外伤性等),黄斑裂孔引起的视网膜脱离,复发性视网膜脱离,无症状性视网膜脱离(包括临床及亚临床型视网膜脱离),既往有玻璃体视网膜手术史,临床数据资料不全患者。分组：研究组符合以下两条标准任何一条(共30眼)：视网膜脱离伴有视网膜下限局线；明确的视力下降或视野遮挡3月以上并与眼底检查结果相符合。不符合上述两条标准者组成对照组(共73眼)；陈旧性视网膜脱离按术后视力是否提高进一步分组分析。手术选择：根据患者视网膜脱离范围、裂孔分布、玻璃体混浊、视网膜增殖等情况以及术者经验和熟练程度分别选择玻璃体切割术或者巩膜扣带术,其中前者根据晶体混浊程度部分联合白内障手术。研究指标：分析性别、年龄、眼别、术前矫正视力、视网膜脱离范围(累及象限数)、裂孔类型、位置、数目、大小、眼轴长度及有无人工晶体等与陈旧性视网膜脱离形成相关因素；术后比较随访时间、视网膜复位及矫正视力提高况及分析影响因素；分析术后未复位原因等。数据分析：使用统计软件SAS9.1,单因素分析计量资料采用T检验或Wilcoxon两样本检验,计数资料以卡方检验或者Fisher精确概率法作成组比较；多因素分析采用Logistic回归分析。结果：陈旧性孔源性视网膜脱离形成的独立危险因素：萎缩性裂孔(OR=7.997p=0.007),下方裂孔(OR=14.127p0.0001),术前矫正视力(OR=1.636 p0.0722);两组视力提高率及视网膜复位率均无显著性差异(p值分别为0.1245、0.7190, Fisher精确概率法)；陈旧性视网膜脱离视力提高与患者病史呈显著相关性(p=0.0345Wilcoxon两样本检验)结论：萎缩性裂孔、下方裂孔、术前矫正视力为陈旧性孔源性视网膜脱离形成的独立危险因素；陈旧性视网膜脱离术后视力提高及复位率与非陈旧性相仿,影响其视力提高主要因素为病史的长短。
[Abstract]:Objective: to analyze the clinical related factors and the effect of surgical treatment of old rhegmatogenous retinal detachment. Design: retrospective case-control study. Participants: admitted to our hospital from June 2008 to November 2010. Patients with primary RRD. Inclusion criteria: symptomatic primary retinal detachment. Under direct or indirect fundus microscopy, it is clear that the retinal tear and retinal detachment extend beyond the equatorial 2DD. Exclusion criteria: secondary retinal detachment (e.g. exudation, traction and trauma, retinal detachment caused by macular holes, etc.). Recurrent retinal detachment, asymptomatic retinal detachment (including clinical and subclinical retinal detachment, previous vitreoretinal surgery), Patients with incomplete clinical data. Group: the study group met any of the following two criteria (30 eyes): retinal detachment with retinal lower limit line; Clear visual acuity or visual field occlusion more than 3 months and consistent with the results of fundus examination. Those who did not meet the above two criteria constituted a control group (73 eyes in total; old retinal detachment according to whether postoperative visual acuity improved or not further group. Analysis. Choice of surgery: according to the range of retinal detachment, The distribution of holes, vitreous opacity, retinal proliferation, and the experience and proficiency of the operators were selected for vitrectomy or scleral buckling, respectively. The former was combined with cataract surgery according to the degree of lens opacity. Study measures: sex, age, eye type, preoperative corrected visual acuity, retinal detachment range (involving quadrant, type, location, number, size) of retinal detachment, The axial length and intraocular lens were associated with the formation of old retinal detachment, the postoperative follow-up time, the improvement of retinal reattachment and corrected visual acuity were compared and the influencing factors were analyzed. Data analysis: statistical software SAS9.1 was used, single factor analysis data were measured by T test or Wilcoxon two-sample test, counting data were compared by chi-square test or Fisher accurate probability method. Multivariate analysis was performed with Logistic regression analysis. Results: the independent risk factors for the formation of old rhegmatogenous retinal detachment were as follows: atrophic hiatus 7.997p0. 007, ORP 14.127p0.0001, preoperative corrected visual acuity OR1.636 p0.0722, the improvement rate of visual acuity and the rate of retina reattachment in both groups. There was no significant difference (P = 0.1245 卤0.7190, Fisher accurate probability method). There was a significant correlation between the improvement of visual acuity in old retinal detachment and the patient's history. Conclusion: atrophic hiatus was found in the atrophic hole, and there was a significant correlation between the visual acuity of the old retinal detachment and the patient's history. The preoperative corrected visual acuity was an independent risk factor for the formation of old rhegmatogenous retinal detachment, and the postoperative visual acuity and reattachment rate of the old retinal detachment were similar to those of the non-old ones, and the main factors affecting the improvement of visual acuity were the length of the history.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.6

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