累及黄斑的孔源性视网膜脱离巩膜扣带术后持续视网膜下积液的临床观察及分析  

Factors related to persistent subretinal fluid after scleral buckling surgery for macula-off rhegmatogenous retinal detachment

作　　者：刘辉[1] 吴苗琴[1] 徐海铭[1] 贺金晶 LIU Hui;WU Miaoqin;XU Haiming(Department of Ophthalmology,Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College),Hangzhou 310014,China)

机构地区：[1]浙江省人民医院( 杭州医学院附属人民医院)眼科,杭州310014

出　　处：《浙江医学》2019年第4期318-321,I0002,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2018RC018);浙江省中医药科技计划项目(2016ZA033)

摘　　要：目的探讨累及黄斑的孔源性视网膜脱离(RRD)患者成功接受巩膜扣带术后发生持续视网膜下积液(PSF)的相关因素以及PSF对患者视力的影响。方法选取成功接受巩膜扣带术的累及黄斑的RRD患者66例66眼,采用多因素logistic回归分析影响PSF发生的相关因素。根据患者是否发生PSF,分为无PSF组、局限性PSF组和弥漫性PSF组3组,并比较3组患者不同随访时间最佳矫正视力(BCVA)的变化情况。结果性别、眼别、病程、术前屈光度、RRD范围、裂孔形态、裂孔数量、裂孔大小、是否环扎、玻璃体腔是否注气与PSF的发生均无关(均P>0.05),而年龄、裂孔位置、术中是否放液与PSF的发生均有关(均P<0.05)。3组患者术后1、3个月BCVA比较差异均有统计学意义(均P<0.05),局限性PSF组和弥漫PSF组BCVA均低于无PSF组(均P<0.05),弥漫性PSF组BCVA均低于局限性PSF组(均P<0.05)。结论 PSF虽不会影响最终的视力恢复,但会延缓患者的视力恢复。本研究提倡巩膜扣带术中尽可能行较为彻底的巩膜外放液,以减少PSF的发生。Objective To investigate the factors related to persistent subretinal fluid(PSF)after scleral buckling surgery for macula-off rhegmatogenous retinal detachment(RRD).Methods The medical records of 66 patients(66 eyes)who underwent successful scleral buckling surgery for macula-off RRD were retrospectively reviewed.The patients were classified into three groups:no PSF(n=33),localized PSF(n=23)and diffuse PSF(n=10).The changes of the best corrected visual acuity(BCVA)in the three groups were compared at different follow-up times.The factors related to PSF were analyzed.Results There was no significant association between PSF and age,gender,symptoms duration,diopter,number of retinal hole,RRD extent,maximum height of the RRD,cerclage and gas tamponade(all P>0.05).Young patients,inferior macula-off retinal detachments and no sclera tapping were associated with persisting postoperative subclinical fluid under the macula for longer periods of time(all P<0.05).There were significant differences in BCVA among the three groups at 1 and 3 month after surgery(both P<0.05).BCVA in localized PSF group and diffuse PSF group was significantly lower than that in no PSF group(all P<0.05).Compared to localized PSF group,the BCVA in diffuse PSF group was significantly reduced(both P<0.05).Conclusion Although the presence of PSF after successful scleral buckle surgery for macular-off RRD make little difference on final visual outcome,it will delay visual recovery.An appropriate sclera tapping is recommended to reduce incidence rate of PSF.

关 键 词：孔源性视网膜脱离 黄斑 巩膜扣带术 视网膜下积液 

分 类 号：R779.6[医药卫生—眼科]