双眼孔源性视网膜脱离患者双眼先后发病特点的对比分析  

Comparative analysis of the characteristics of bilateral rhegmatogenous retinal detachment

作　　者：周金琼[1] 魏文斌[1] 游启生[2] 屠颖[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所,100730

出　　处：《中华眼科杂志》2016年第5期348-353,共6页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金项目（81272981）;北京市自然科学基金项目（7112031）

摘　　要：目的对比分析双眼原发性孔源性视网膜脱离（RRD）患者先后患病眼间的发病特点及可能与双眼间发病间隔时间相关的因素。方法回顾性研究。研究对象为2000年1月至2014年1月到北京同仁医院眼科就诊的RRD患者共8283例，其中双眼RRD603例（7．30％）。观察并记录其临床相关信息，包括首次发病年龄、双眼RRD发生的间隔时间、先后发病眼近视与否、外伤史等。对于正态分布数据的组问比较，采用两独立样本t检验，对于二分类资料的组间比较采用卡方检验，对于可能与双眼间发病间隔时间相关的危险因素的分析采用二分类资料的Logistic回归分析。结果603例双眼RRD患者首发眼平均患病年龄为（30．76±15．31）岁（范围：2．13～68．35岁）。双眼同时发现RRD者占4．80％，而其他双眼先后发病者中，以左眼为先发眼者较为多见（303例），占52．90％。与后发病眼相比，先发眼多存在黄斑区脱离（x2=4．37，P=0．03，OR=1．59，95％CI：1．04～2．45）、视网膜下增殖（X2=21．81，P=0．04，OR：1．57，95％CI：1．02～2．42）。先后发病眼间RRD发生的平均间隔时间为（3．73±7．06）年（范围：0～56年）。首发眼发病年龄较小f（29．56±15．47）岁，t=-4．09，P〈0．01]、自觉症状较重者双眼间发病间隔时间较短。先发病眼黄斑区脱离、视网膜脱离为巨大裂孔、马蹄形裂孔所致、裂孔位于颞上方、存在视网膜变性者发病间隔时间较短。而对于近视患眼而言，中低度近视者较高度近视者双眼间发病间隔时间较短，后发病眼外伤史也可导致发病间隔时间的缩短。结论对于初诊表现为单眼RRD的患者，无论年龄大小，均需终身随访，尤其是先发眼发病后的1年内，关注其对侧眼RRD发生的可能。发病年龄偏小、自觉症状较重、存在黄斑区脱离、马蹄形裂孔、颞上视网膜裂孔、视网膜�Objective To investigate the characteristics of bilateral rhegmatogenous retinal detachment （RRD） in a hospital-based population. Methods Six hundred and three patients diagnosed with bilateral RRD in the Beijing Tongren Hospital between January 2000 and January 2014 were identified and included into the study. The clinical features including the age when retinal detachment occurrence, time interval between the occurrence of the bilateral RRDs, predisposing characteristics such as myopia, trauma, et al. were recorded by a chart review. Results Out of 8 283 patients treated for primary RRD in the study period, （7.30±2.45）%（603 patients）developed a RRD in the contralateral eye, with a mean age of （30.76± 15.31）years （range： 2-68）when the first RRD occurred. 4.8% of the patients primarily presented with a simultaneous bilateral RRD. Most RRD occulted firstly in the left eye （52.90%）. Compared with the follow eye, the first RRD occurred with more macula detachment （P=0.03, OR： 1.59,95%CI： 1.04-2.45） and retinal proliferation （P=0.04, OR： 1.57, 95% CI： 1.02-2.42）, the visual outcome was more worse. Mean interval between the bilateral RRDs was （3.73±7.05） years （mean±standard deviation, range： 0-56 years） The younger, more severe symptoms of the firstly occurred RRD, the shorter interval between the bilateral RRD. Time interval between the bilateral RRD was shorter in those RRD firstly occurred with macula detachment, giant tears, horse-shoe tear, located in the temporal superior region, or with retinal degeneration. Compared with highly myopic eyes, the interval between the bilateral RRD were shorter in moderately myopic eyes. Conclusions For patients newly diagnosed with RRD, regardless of age, are required to a lifelong follow-up for the contralateral eye, especially within one year. Patients who were young, with heavier symptoms, low to moderate myopia or present with retinal degeneration, should be closely followed up in a short time after the first RRD occur

关 键 词：视网膜脱离 视网膜穿孔 时间因素 

分 类 号：R774.12[医药卫生—眼科]