805例无晶状体眼和人工晶状体眼视网膜脱离的临床特征及治疗效果  

Clinical characteristics and therapeutic effect of retinal detachment in aphakic and pseudophakic eyes in 805 patients

作　　者：邹海东[1] 张皙[1] 许迅[1] 

机构地区：[1]上海交通大学医学院附属第一人民医院眼科,200080

出　　处：《中华眼底病杂志》2010年第1期47-51,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察无晶状体状眼视网膜脱离（ARD）和人工晶状体眼视网膜脱离（PPRD）的临床特征及其治疗效果。方法回顾性分析ARD和PPRD患者798例805只眼的临床资料。手术前对患者进行视力、屈光度、眼压检查，以及裂隙灯显微镜、直接和（或）间接检眼镜检查。805只眼中，ARD321只眼，PPRD484只眼，手术前最佳矫正视力为光感～0．6。主要根据患眼增生性玻璃体视网膜病变（PVR）分级和视网膜裂孔情况对患者采取巩膜外手术或玻璃体视网膜手术结合巩膜手术。根据手术时间将805只眼分成1995～1999年和2000～2007年两组，前者243只眼，后者562只眼。手术后随访3～25个月，平均随访时间12．3个月，以最后一次随访作为疗效判断时间点，以视网膜解剖复位作为疗效判断标准。每次随访都采用手术前同样方法进行检查，并记录手术并发症。采用Mantel—Haenszel卡方检验比较不同时间组中PPRD的构成比例，手术前患眼的视力、眼部病变、手术方式、手术结果和手术后视力等差异。结果805只眼中，晶状体摘除至视网膜脱离发病的平均时间间隔为：PPRD眼15．4个月，ARD眼39．1个月。手术后视网膜解剖复位率为95．9％。只作巩膜外手术眼复位率93．5％，玻璃体手术跟复位率97．2％。805只眼中，手术后矫正视力在0．3以上者11．9％，与手术前相比提高2行以上者67．3％。PPRD与ARD比较，症状发生早，全玻璃体后脱离比例高，PVR更严重，视网膜脱离范围更广泛，手术前视网膜裂孔检出率低，解剖复位率略低。2000～2007年组患者中，PPRD比例、采用玻璃体手术比例、总体复位率、最后一次随访时较佳视力比例均高于1995～1999年组。结论ARD和PPRD眼内病变临床特征较为复杂，其治疗效果正在不断提高。Objective To observe the clinical characteristics and therapeutic effect of aphakic retinal detachment （ARD） eyes and pseudophakic retinal detachment （PPRD） eyes. Methods The clinical data of 805 patients, including 321 ARD and 484 PPRD eyes were retrospectively analyzed. The patientstvisiual acuity, refraction, intraocular pressure were examined, and the patients also underwent slit-lamp microscopy and direct and （or） indirect ophthalmoscopy. The preoperative best-corrected visual acuity （BCVA） was between light perception （LP） and 0.6. Mainly according to the PVR grade and retinal holes position to take the scleral buckling or vitrectomy combined with scleral buckling. The 805 eyes were divided into 1995-1999 group （243 eyes） and 2000-2007 group （562 eyes） according to operative time. The follow-up ranged from 3 to 25 months, with an average of 12.3 months. The success standard of surgery was set as anatomic retinal reattachment and the last follow-up time was considered as the judgment time. The surgical complications were recorded at each follow-up time points. The composition of PPRD, the visual acuity, ocular lesions, surgical methods and results before operation and visual acuity after operation in two groups were analyzed and compared by Mantel-Haenszel chi-square test. Results The average interval from lens extraction to RD occurrence was 15. 4 months in PPRD eyes and 89.1 months in ARD eyes. The final total anatomic success rate was 95. 9%, and was 93.5% in the scleral buckle eyes and 97.2% in vitrectomy eyes. The BCVA was better than 0.3 after operation only in 11. 9% of the 805 patiens, and the visual acuity increased more than 2 lines in 67.3%. Compared with the ARD eves, early onset, high proportion of total posterior vitreous detachment, severe PVR, wide RD range, low detection rate of retinal hole and low antomie success rate were found in PPRD eyes. Compared with the 1995 1999 group, the proportion of vitreous surgery, anatomic success rate and better visual acuity wer

关 键 词：视网膜脱离/病因学 视网膜脱离/诊断 视网膜脱离/外科学 无晶状体 白内障后 有晶状体眼人工晶状体植入术 

分 类 号：R774.1[医药卫生—眼科] R779.66[医药卫生—临床医学]