影响巩膜扣带术视网膜复位及视力恢复因素的临床观察  

Clinical observation of risk factors affecting the anatomical reattachment and visual recovery after scleral buckling

作　　者：吴文芳[1] 吴强[1] 宋蓓雯[1] 杜新华[1] 陈颖[1] 

机构地区：[1]上海交通大学附属上海第六人民医院眼科,上海市200233

出　　处：《中国实用眼科杂志》2010年第6期583-587,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨巩膜扣带术（scleral buckling,SB）治疗孔源性视网膜脱离（rhegmatogenous retinal detachment,RRD）的疗效以及影响视网膜解剖复位和视力恢复的相关危险因素.方法 回顾性分析2005年1月至2008年12月行sB的RRD患者72例（72只眼）.术后随访6-30月,平均（13.96±8.28）月,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.Logistic回归用于分析影响视网膜解剖复位和视力恢复的相关危险因素.结果 在眼底镜和B超检测下视网膜首次复位率为90.28%,最终复位率为97.22%;而光学相干断层扫描（optical coherence tomography,OCT）检测下的视网膜首次复位率为59.72%,最终复位率为77.78%.术后BCVAI〉0.3者为62.5%.C1级PVR和多发性裂孔对视网膜复位率有显著影响（P=0.0183、0.0181 ）.术前视力、黄斑脱离与否、黄斑脱离时间及PVR的程度对术后视力恢复的影响有统计学意义（P=0.0235、0.0124、0.0325、0.0357）. 术后出现葡萄膜炎占13.89%,视物变形占9.72%,增殖性玻璃体视网膜病变（proliferative vitreous retinopathy,PVR）进展占6.94%,黄斑皱褶占6.94%,高眼压占4.17%,复视占2.78%.术后前房深度、眼轴长度、屈光度和散光度的变化较术前差异有统计学意义（P=0.0260、〈0.0001、0.0005、0.0018）.结论 SB治疗RRD有良好的疗效,但C1级PVR和多发性裂孔会显著增加手术失败的风险.术前视力、黄斑脱离状态和脱离时间及PVR的程度是影响术后视力恢复的重要因素;同时,该手术可导致术后前房深度变浅、眼轴延长、屈光度和散光度向负值偏移.Objective To discuss the effect of treatment of rhegmatogenous retinal detachments （RRD） by scleral buckling surgery as well as the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Methods Seventy-two patients （72 eyes） with RRD treated by scleral buckling surgery in our hospital during January 2005 to December 2008 were retrospectively analyzed. Patients were followed up for 6 to 30 months, an average of （13.96± 8.28） months, and observed the rate of postoperative retinal anatomic reattachment, the best corrected visual acuity （BCVA） and complications. The Logistic regression was used to analyze the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Results Retinal reattachment was achieved in 90.28% after initial surgery and the final success rate for anatomic reattachment was 97.22% assessed with ophthalmoscope and B-mode ultrasonography. But the first and final retinal reattachment rates assessed with the optical coherence tomography （OCT） were 59.72% and 77.78% respectively. Postoperative BCVA =0.3 reached to 62.5%. Retinal reattachment was affected by Grade Cl PVR and multiple breaks （P=0.0183 and P=0.0181, respectively）. Preoperative visual acuity , macular detachment status and time, as well as the grade of PVR affected visual recovery significantly （P =0.0235, P =0.0124, P=0.0325 and P=0.0357, respectively）. The complications included uveitis （13.89%）, dysmorphopsia （9.72%）, proliferative vitreous retinopathy （6.94%）, macular pucker （6.94%）, ocular hypertension （4.17%） and diplopia （2.78%）. After SB, the anterior chamber depth, axial length, re fraction and astigmatism were all changed significantly （P=0.0260, P〈0.0001, P=0.0005 and P=0.0018, re spectively） than before. Conclusions Scleral buckling is an effective technique for managing RRD, but grade Cl PVR and multiple breaks are significant risk factors for anatomic failure. Preoperative visual acuity, macular detach

关 键 词：孔源性视网膜脱离 巩膜扣带术 增殖性玻璃体视网膜病变 光学相干断层扫描 

分 类 号：R774.130.5[医药卫生—眼科]