高度近视黄斑裂孔性视网膜脱离解剖复位后的视力预后  

Visual prognosis of retinal detachment due to high myopic macular hole after anatomical success

作　　者：许艳[1] 陈松[1] 

机构地区：[1]天津医科大学眼科临床学院,天津市眼科医院,天津市眼科研究所,天津市300020

出　　处：《眼科新进展》2011年第1期64-67,共4页Recent Advances in Ophthalmology

摘　　要：目的研究高度近视黄斑裂孔性视网膜脱离(retinal detachment,RD)解剖复位后视力预后与预计影响因素之间的关系。方法对71例行玻璃体切割联合硅油填充术后解剖复位的高度近视黄斑裂孔性RD患者进行回顾性分析。单因素或多因素分析法分析性别、年龄、屈光度、眼轴长度、后巩膜葡萄肿、病程、孔径、RD脱离范围、内界膜剥离与否、黄斑裂孔(macularhole,MH)是否闭合与视力预后的关系。结果术后视力提高组55例(78%),视力不变组16例(22%)。视力提高组、视力不变组的眼轴长度分别为(26.2±1.2)mm、(31.1±1.5)mm;病程分别为(1.39±1.57)个月、(4.06±3.94)个月;孔径分别为(443.29±143.61)μm、(627.25±165.84)μm(P<0.01或P<0.05)。伴随后巩膜葡萄肿者分别为32例、14例,不伴随后巩膜葡萄肿者分别为23例、2例;RD脱离范围≤2个象限者分别为25例、2例,>2个象限者分别为30例、14例;MH闭合者分别为31例、4例,未闭合者24例、12例。2组患者眼轴长度、后巩膜葡萄肿、病程、孔径、RD脱离范围、MH是否闭合差异均有统计学意义(均为P<0.05)。多因素Logistic回归分析结果显示:术前因素中病程(OR=2.531,P=0.005)、孔径(OR=2.801,P=0.021)是影响视力预后的独立危险因素,MH闭合(OR=2.990,P=0.039)的患者术后视力相对较好。结论病程短、孔径小的患者视力预后好,MH闭合可以增加患者术后视力提高的几率。Objective To detect the prognostic factors associated with visual acuity after anatomical success of retinal detachment due to high myopic macular hole.Methods A retrospective review of a consecutive series of 71 patients（71 eyes）,who were with anatomical success after vitrectomy with silicon oil tamponade for retinal detachment due to high myopic macular hole,was taken.The multiple factors related with visual prognosis including gender,age,preoperative refraction,axial length,posterior staphyloma,duration of onset,size of macular hole,extent of retinal detachment,internal limiting membrane（ILM）peeling or not and postoperative macular hole closed or not were analyzed.The data was statistically analyzed using univariate analysis or multivariate analysis.Results About 55 eyes（78%）had better visual acuity after surgery,and visual acuity of 16 eyes（22%）were similar to before.In visual acuity improved group and visual acuity unchanged group,the axial length were（26.2±1.2）mm,（31.1±1.5）mm;The duration of onset were（1.39±1.57）months,（4.06 ±3.94）months;The size of macular hole were（443.29±143.61）μm,（627.25±165.84）μm（P0.01 or P0.05）;There were 33 eyes,17 eyes to accompanying posterior staphylom;There were 19 eyes,2 eyes no accompanying posterior staphylom;About 25 eyes and 2 eyes whose extent of retinal detachment were similar or small than 2 quadrants;About 30 eyes and 14 eyes whose extent of retinal detachment were bigger than 2 quadrants;Macular hole closed were 31 eyes and 4 eyes;Macular hole no closed were 24 eyes and 12 eyes between the two groups.There were significant difference of axial length,posterior staphylom,duration of onset,size of macular hole,extent of retina detachment and postoperative macular hole closed or not among the two groups（all P0.05）.Multivariate logistic regression analysis revealed that the duration of onset（OR=2.531,P=0.005）,size of macular hole（OR=2.801,P=0.021）were the only variable factor affecting the visual acuity.Patients

关 键 词：高度近视黄斑裂孔 视网膜脱离 玻璃体切割术 视力 

分 类 号：R778.1[医药卫生—眼科]