硅油取出手术后视网膜再脱离的发生原因和影响因素  

Causes and risk factors of recurrent retinal detachment after silicone oil removal

作　　者：孟白军[1] 高永峰[1] 王艳婷[1] 

机构地区：[1]河南省眼科研究所河南省立眼科医院,郑州450003

出　　处：《中华眼底病杂志》2013年第5期499-504,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的探讨复杂视网膜脱离眼硅油取出手术后视网膜再脱离（RRD）的影响因素及发生原因。方法回顾性研究。选择行玻璃体切割联合硅油填充手术的连续患者455例458只眼纳入研究。对所有患者行玻璃体切割手术，手术中根据眼内情况酌情行重水、剥膜、视网膜切开或部分切割、眼内激光光凝或冷冻、气液交换或直接油液交换等操作。对伴多发裂孔、陈旧性视网膜脱离、增生及牵拉病变较严重者行环扎手术98只眼。手术完毕时玻璃体腔内填充硅油。硅油取出手术中眼底检查发现有需处理的视网膜前膜者，行切断、剥膜或切除及360。预防性激光光凝治疗等操作，手术中发现裂孔或可疑裂孔者行眼内激光光凝或冷冻治疗。硅油取出手术后1周内及随诊期间均采用与手术前相同的设备和方法行视力、眼压、裂隙灯显微镜、检眼镜等检查。依据硅油取出手术后有无RRD将患眼分为复位组、再脱离组，分别为419、39只眼。对患者年龄、眼轴长度、玻璃体切割手术前最小分辨角对数（LogMAR）最佳矫正视力（BCVA）和眼压、硅油取出手术前LogMARBCVA和眼压、视网膜裂孔数目、硅油填充时间、随访时间、硅油取出手术后眼压和视力以及玻璃体切割手术和硅油取出手术中相关因素进行记录。统计年龄、性别、高度近视、巨大裂孔、下方裂孔、黄斑裂孔、无晶状体眼、增生性玻璃体视网膜病变（PVR）C3级及以上、既往视网膜脱离手术失败史、360。预防性激光光凝、联合环扎、角膜穿刺取硅油与硅油取出手术后发生RRD的关系。计算年龄〈40岁、性别等因素的比值比（OR）及其95％可信区间（CI）。将高度近视眼、联合巩膜环扎及经角膜穿刺硅油取出纳人多元回归方程。结果硅油取出手术后患眼平均LogMARBCVA为0．86±0．63，复位组、再脱离组平均LogMARBCVA分别为0．82±0�Objective To investigate the main causes and risk factors of recurrent retinal detachment （RRD） after silicone oil removal （SOR） in eyes with complex retinal detachment. Methods It was a retrospective case series study. A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study. All patients underwent vitrectomy operation. Additionally, they were given heavy water, membrane peeling, retinotomy or partial cutting, intraocular laser photocoagulation or frozen, gas-liquid exchange or direct oil exchange operation accordingly. Ninety-eight eyes with multiple holes, old retinal detachment, hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously. Infravitreal silicone oil was padded at the end of operation. Cutting, stripping or resection and 360% preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR. Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation. One week after SOR and during follow-up, the visual acuity, intraocular pressure （IOP）, slit lamp microscope, and ophthalmoscope examination were examined with the same technique and methods as preoperation. The eyes were divide into two groups based on the attachment status of retina after SOR, which were reattached group （419 eyes） and redetached group （39 eyes） respectively. The following data were recorded： the age of patients, ocular axial length, logarithm of minimum angle of resolution （logMAR） best corrected visual acuity （BCVA） and IOP be{ore vitrectomy operation and before and after SOR, the number of retinal breaks, the duration of silicone oil filling, the duration of follow-up, and the related %actors during vitreetomy operation and SOR. The relation of age, sex, high myopia, the size and location of holes, aphakic eye, proliferative vitreoretinopathy （PVR） C3 level and above, previous histor

关 键 词：视网膜脱离 病因学 视网膜脱离 外科学 复发 危险因素 硅油类 

分 类 号：R779.6[医药卫生—眼科]