巩膜扣带治疗孔源性视网膜脱离术后视网膜色素上皮脱离的临床分析
发布时间：2018-08-20 16:25
【摘要】： 研究目的： 孔源性视网膜脱离(rhegmatogenous retinal detachment, RRD)发生在视网膜裂孔形成的基础上,由液化的玻璃体经裂孔进入视网膜神经上皮层与色素上皮层之间,造成二者分离。由于脉络膜对视网膜外层的营养供应被阻断,尤其累及黄斑后视力急剧减退,是严重的致盲性眼病。 RRD手术目的在于寻找并封闭所有的视网膜裂孔,消除和缓解玻璃体视网膜牵拉,促使视网膜神经上皮层与色素上皮层贴附。目前常用的巩膜扣带术包括巩膜加压术、巩膜环扎术,并联合放视网膜下积液和玻璃体腔注射液体或气体,对不伴有严重增殖性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)的病例,其手术成功率能达到95%以上。随着玻璃体显微手术的发展,一些复杂视网膜脱离的治疗也取得了很大改观。 但是RRD术后并发症严重影响术后视功能的恢复,甚至威胁眼球的存亡。本文通过分析109例接受巩膜扣带术治疗的RRD患者的临床资料,总结巩膜扣带治疗RRD术后的并发症。并报道17例术后视网膜色素上皮(retinal pigment epithelium, RPE)脱离,探讨巩膜扣带术后发生RPE脱离的机制及防治措施。 研究方法： 1.病例：收集2008-07-01至2009-10-31在山东大学齐鲁医院眼科行巩膜扣带术的107例RRD患者共109只眼。其中男性患者51例,女性56例,最小年龄9岁,最大78岁。 2.手术分类：根据手术加压方式分为以下几种：(A1)巩膜环扎术18例,(A2)垂直角膜缘放置压垫53例,(A3)平行角膜缘放置压垫38例。根据是否放视网膜下液分为：(B1)放视网膜下液95例,(B2)不放视网膜下液14例。 3.随访：采取门诊方式对患者进行随访,时间分别为：术后0.5个月103例、1.5个月97例、3个月89例、6个月77例。主诉视物变形者,经散瞳查眼底及光学相干断层成像(optical coherence tomography, OCT)检查,确诊发生RPE脱离的,给予口服强的松治疗。 4.观察指标：对随诊病人查最佳矫正视力、散瞳查眼底、眼科B超检查,主诉视物变形者或高度怀疑发生RPE脱离者行OCT检查,必要时行眼底荧光血管造影(fundus fluorescein angiography, FFA)或吲哚青绿血管造影(indocyanine green angiography, ICGA)。所获数据采用SPSS (Statistics17.0)软件包进行统计分析,以p0.05作为差异有统计学意义的检验标准。根据统计结果,分析RPE脱离的患病率是否有年龄、性别及手术方式的统计学差异。确诊发生RPE脱离的患者,口服强的松治疗。并对激素治疗效果进行评估。 结果： 一、基本资料： 本组入选病例包括107例RRD患者共109只眼。 其中男性患者51例,女性56例。最小年龄9岁,最大78岁。根据患者主诉,发病时间从3天至1年余不等。 术前视力0.3者78例,0.3～0.6者27例,0.6者4例。 按照美国视网膜学会命名委员会的PVR分级标准(1983),A级24例,B级41例,C1级30例,C2级14例。 二、网膜复位情况：术后0.5个月网膜复位90例、1.5个月复位85例、3个月复位83例、6个月复位77例。 三、术后视力： 随访0.5个月103例、1.5个月97例、3个月89例、6个月77例,最佳矫正视力平均数分别为0.4146、0.4670、0.4933、0.5312。 四、并发症： 术后屈光改变(相差1.OOD以上)49(44.95%)例,OCT查见黄斑区结构变化：黄斑区水肿19(17.43%)例、黄斑前膜5(0.92%)例、RPE脱离17(15.60%)例。术后0.5月神经上皮层脱离12(11.65%)例。 五、RPE脱离： 术后17例患者发生RPE脱离。统计分析显示：巩膜扣带治疗RRD术后的RPE脱离好发于青壮年(年龄中位数30.0000岁),平行角膜缘较垂直角膜缘放置压垫者居多(p=0.0010.0125),不放液多于放液组(p=0.0010.05),但无性别差异(p=0.1250.05)。经糖皮质激素治疗后视力可得到一定程度的提高,但长期疗效有待进一步观察。 结论： (1)巩膜扣带治疗孔源性视网膜脱离术后可发生RPE脱离,推测可能与手术操作造成脉络膜循环障碍及术后炎症因子释放有关。(2)巩膜扣带术后RPE脱离好发于青壮年,以平行角膜缘放置压垫者居多,不放液多于放液,无性别差异。(3)激素治疗有效。
[Abstract]:Research purposes:
Rhegmatogenous retinal detachment (RRD) occurs on the basis of retinal hiatus formation. The liquefied vitreous body enters the retinal neuroepithelial layer and the retinal pigment epithelial layer through the retinal hiatus, resulting in the separation of the two. The choroidal nutrient supply to the outer retinal layer is blocked, especially after macular involvement. Dramatic decline is a serious blinding eye disease.
RRD surgery aims at finding and closing all retinal holes, eliminating and alleviating vitreoretinal traction, and promoting the attachment of retinal neuroepithelium to the pigment epithelium. Currently commonly used scleral buckling surgery includes scleral compression, scleral ligation, and combined release of subretinal effusion and vitreous cavity injection of body or gas, right With the development of vitreous microsurgery, the treatment of complicated retinal detachment has been improved greatly.
However, the postoperative complications of RRD seriously affect the recovery of visual function, even threaten the survival of the eyeball. This paper summarizes the complications of scleral buckling for RRD by analyzing the clinical data of 109 patients with RRD who received scleral buckling. 17 cases of postoperative retinal pigment epithelium (RPE) detachment and exploration were reported. To discuss the mechanism and prevention measures of RPE detachment after scleral buckling surgery.
Research methods:
1. Case: A total of 109 eyes of 107 RRD patients who underwent scleral buckling from July 2008 to October 2009 in Qilu Hospital of Shandong University were collected.
2. Operative classification: According to the way of compression, there were 18 cases of scleral cerclage, (A2) 53 cases of vertical corneal limbus, and (A3) 38 cases of parallel corneal limbus.
3. Follow-up: 103 patients were followed up at 0.5 months, 97 patients at 1.5 months, 89 patients at 3 months and 77 patients at 6 months after operation. Patients complaining of visual deformity were diagnosed with RPE detachment by mydriasis and optical coherence tomography (OCT).
4. Observation indicators: Optimal corrected visual acuity, mydriasis, fundus examination, B-ultrasonography, OCT examination in patients with deformed vision or highly suspected RPE detachment, fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA) if necessary. Data were analyzed by SPSS (Statistics 17.0) software package, and P0.05 was used as the test standard of statistical significance. According to the statistical results, the prevalence of RPE detachment was analyzed whether there were statistical differences in age, sex and surgical methods. Assessment.
Result:
First, basic information:
This group included 107 patients with RRD and 109 eyes.
Among them, 51 were male and 56 were female. The youngest was 9 years old and the oldest was 78 years old.
Preoperative visual acuity was 0.3 in 78 cases, 0.3 to 0.6 in 27 cases, and 0.6 cases in 4 cases.
According to the American Retinal Society Nomenclature Committee (1983), there were 24 cases of grade A, 41 cases of grade B, 30 cases of grade C1 and 14 cases of grade C2.
Second, omentum reduction: 0.5 months after surgery, omentum reduction in 90 cases, 1.5 months in 85 cases, 3 months in 83 cases, 6 months in 77 cases.
Three, postoperative visual acuity:
103 cases were followed up for 0.5 months, 97 cases for 1.5 months, 89 cases for 3 months and 77 cases for 6 months. The average best corrected visual acuity was 0.4146, 0.4670, 0.4933 and 0.5312, respectively.
Four, complications:
There were 49 (44.95%) cases with refractive changes (the difference was more than 1.OOD), 19 (17.43%) cases with macular edema, 5 (0.92%) cases with macular anterior membrane, and 17 (15.60%) cases with RPE detachment.
Five, RPE departure:
RPE detachment occurred in 17 patients after scleral buckling for RRD. Statistical analysis showed that RPE detachment was predominant in young adults (median age 30.0000 years). The incidence of RPE detachment was higher in parallel corneal limbus than that in vertical corneal limbus (p = 0.0010.0125). There was no gender difference (p = 0.1250.05). After treatment, the visual acuity can be improved to a certain extent, but the long-term effect needs further observation.
Conclusion:
(1) RPE detachment may occur after scleral buckling for rhegmatogenous retinal detachment, which may be related to choroidal circulation disturbance caused by operation and postoperative inflammatory factors release. (2) RPE detachment after scleral buckling occurs frequently in young adults, and most of them place pressure pads parallel to corneal limbus, without drainage more than drainage, without gender difference. (3) Hormone therapy. The treatment is effective.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.12
本文编号：2194262
[Abstract]:Research purposes:
Rhegmatogenous retinal detachment (RRD) occurs on the basis of retinal hiatus formation. The liquefied vitreous body enters the retinal neuroepithelial layer and the retinal pigment epithelial layer through the retinal hiatus, resulting in the separation of the two. The choroidal nutrient supply to the outer retinal layer is blocked, especially after macular involvement. Dramatic decline is a serious blinding eye disease.
RRD surgery aims at finding and closing all retinal holes, eliminating and alleviating vitreoretinal traction, and promoting the attachment of retinal neuroepithelium to the pigment epithelium. Currently commonly used scleral buckling surgery includes scleral compression, scleral ligation, and combined release of subretinal effusion and vitreous cavity injection of body or gas, right With the development of vitreous microsurgery, the treatment of complicated retinal detachment has been improved greatly.
However, the postoperative complications of RRD seriously affect the recovery of visual function, even threaten the survival of the eyeball. This paper summarizes the complications of scleral buckling for RRD by analyzing the clinical data of 109 patients with RRD who received scleral buckling. 17 cases of postoperative retinal pigment epithelium (RPE) detachment and exploration were reported. To discuss the mechanism and prevention measures of RPE detachment after scleral buckling surgery.
Research methods:
1. Case: A total of 109 eyes of 107 RRD patients who underwent scleral buckling from July 2008 to October 2009 in Qilu Hospital of Shandong University were collected.
2. Operative classification: According to the way of compression, there were 18 cases of scleral cerclage, (A2) 53 cases of vertical corneal limbus, and (A3) 38 cases of parallel corneal limbus.
3. Follow-up: 103 patients were followed up at 0.5 months, 97 patients at 1.5 months, 89 patients at 3 months and 77 patients at 6 months after operation. Patients complaining of visual deformity were diagnosed with RPE detachment by mydriasis and optical coherence tomography (OCT).
4. Observation indicators: Optimal corrected visual acuity, mydriasis, fundus examination, B-ultrasonography, OCT examination in patients with deformed vision or highly suspected RPE detachment, fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA) if necessary. Data were analyzed by SPSS (Statistics 17.0) software package, and P0.05 was used as the test standard of statistical significance. According to the statistical results, the prevalence of RPE detachment was analyzed whether there were statistical differences in age, sex and surgical methods. Assessment.
Result:
First, basic information:
This group included 107 patients with RRD and 109 eyes.
Among them, 51 were male and 56 were female. The youngest was 9 years old and the oldest was 78 years old.
Preoperative visual acuity was 0.3 in 78 cases, 0.3 to 0.6 in 27 cases, and 0.6 cases in 4 cases.
According to the American Retinal Society Nomenclature Committee (1983), there were 24 cases of grade A, 41 cases of grade B, 30 cases of grade C1 and 14 cases of grade C2.
Second, omentum reduction: 0.5 months after surgery, omentum reduction in 90 cases, 1.5 months in 85 cases, 3 months in 83 cases, 6 months in 77 cases.
Three, postoperative visual acuity:
103 cases were followed up for 0.5 months, 97 cases for 1.5 months, 89 cases for 3 months and 77 cases for 6 months. The average best corrected visual acuity was 0.4146, 0.4670, 0.4933 and 0.5312, respectively.
Four, complications:
There were 49 (44.95%) cases with refractive changes (the difference was more than 1.OOD), 19 (17.43%) cases with macular edema, 5 (0.92%) cases with macular anterior membrane, and 17 (15.60%) cases with RPE detachment.
Five, RPE departure:
RPE detachment occurred in 17 patients after scleral buckling for RRD. Statistical analysis showed that RPE detachment was predominant in young adults (median age 30.0000 years). The incidence of RPE detachment was higher in parallel corneal limbus than that in vertical corneal limbus (p = 0.0010.0125). There was no gender difference (p = 0.1250.05). After treatment, the visual acuity can be improved to a certain extent, but the long-term effect needs further observation.
Conclusion:
(1) RPE detachment may occur after scleral buckling for rhegmatogenous retinal detachment, which may be related to choroidal circulation disturbance caused by operation and postoperative inflammatory factors release. (2) RPE detachment after scleral buckling occurs frequently in young adults, and most of them place pressure pads parallel to corneal limbus, without drainage more than drainage, without gender difference. (3) Hormone therapy. The treatment is effective.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.12
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