空气填充在孔源性视网膜脱离玻璃体切割手术中的临床应用及影响因素分析  

Efficacy and impacts of air tamponade combined with vitrectomy in the treatment of rhegmatogenous retinal detachment

作　　者：俞莹[1] 曾论 杨忠凯 朱蓉嵘[1] 薛盛丁 陈辉[1] Yu Ying;Zeng Lun;Yang Zhongkai;Zhu Rongrong;Xue Shengding;Chen Hui(Department of Ophthalmology,Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Ophthalmology,Wuxi Ninth People's Hospital,Wuxi 214062,China;Department of ENT,Karamay People's Hospital,Karamay 830054,China)

机构地区：[1]南通大学附属医院眼科,226001 [2]无锡市第九人民医院眼科,214062 [3]克拉玛依市人民医院五官科,830054

出　　处：《中华眼底病杂志》2020年第8期605-610,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(81700853);中国博士后科学基金面上资助(2019M651927)。

摘　　要：目的观察和评价玻璃体切割手术(PPV)联合空气填充治疗孔源性视网膜脱离(RRD)的疗效和安全性,初步探讨其影响因素。方法前瞻性非随机对照研究。2016年11月至2018年12月于南通大学附属医院眼科行PPV治疗的RRD患者110例110只眼纳入研究。患者充分了解病情及手术方式后志愿选择手术方式。其中,空气填充组90例90只眼,硅油填充组20例20只眼。两组患者年龄(t=-0.082)、性别构成比(χ^2=1.538)、眼别(χ^2=0.839)、平均病程(Z=-0.276)、眼压(t=3.669)、眼轴长度(t=0.765)、增生性玻璃体视网膜病变分级(Z=-2.101)、高度近视(χ^2=0.013)、晶状体状态(χ^2=1.275)、logMAR BCVA(t=-0.681)、视网膜脱离范围(t=-0.970)、裂孔位置(χ^2=0.108)和数量(t=0.158)、是否累及黄斑(χ^2=1.791)比较,差异均无统计学意义(P>0.05)。所有患者均行标准经睫状体平坦部三通道25G PPV,玻璃体空气、硅油填充分别为90、20只眼。手术后随访时间为1、3、6个月。对比观察两组患眼首次视网膜复位率、BCVA增加倍率和恢复速率、眼压、中心凹视网膜厚度(CFT)、椭圆体带和交叉结合带的变化以及手术后并发症发生情况。两组间等级资料比较采用秩和检验(Mann-Whitney U),分类资料采用χ^2检验,定量资料采用独立样本t检验。组内不同时间点定量资料比较采用单因素方差分析。结果首次手术后,空气组、硅油组视网膜复位分别为87(96.6%)、19(95.0%)只眼。两组患眼视网膜复位率比较,差异无统计学意义(χ^2=0.130,P>0.05)。空气组、硅油组下方裂孔7、2只眼,均一次手术视网膜复位。手术后6个月,空气组、硅油组患眼logMAR BCVA分别为0.23±0.23、0.37±0.23;均较手术前提高,差异有统计学意义(t=-2.410,P<0.001);空气组患眼BCVA优于硅油组,差异有统计学意义(P<0.05)。空气组、硅油组患眼BCVA增加倍率分别为0.69±0.28、0.48±0.30 logMAR单位,两组间差异有统计学意义(t=-3Objective To evaluate the efficacy and impacts of air tamponadein treating rhegmatogenous retinal detachments(RRD)including inferior breaks after 25G pars plana vitrectomy(PPV).Methods A prospective non-randomized study.From November 2016 to December 2018,110 RRD patients receiving PPV in the Ophthalmology Department of Affiliated Hospital of Nantong University were included in the study.All the patients choose the operation mode voluntarily after fully understand the condition and operation mode.There were 90 eyes in the air filling group and 20 eyes in the silicone oil filling group.There was no difference of age(t=-0.082),sex ratio(χ^2=1.538),left or right eye(χ^2=0.839),average course of disease(Z=-0.276),intraocular pressure(t=3.669),axial length(t=0.765),grade of proliferative vitreous retinopathy(Z=-2.101),high myopia(χ^2=0.013),lens state(χ^2=1.275),logMAR BCVA(t=-0.681),the scope of retinal detachment(t=0.970),the site(χ^2=0.108)and numbers(t=0.158)of the retinal holes,whether involving macula(χ^2=1.791)between the two groups(P>0.05).At 1,3,and 6 months after surgery,the first retinal reduction rate,BCVA increase rate,visual recovery rate,intraocular pressure,fovea retinal thickness(CFT),ellipsoid and cross sectional area,and the occurrence of postoperative complications in the two groups were observed and compared.Independent sample t test and Chi-squared test,Mann-Whitney U test,and ANOVA were used for data comparision.Results After the first operation,retinal reattachmnents were achieved in 87 eyes(96.6%)in the air group and 19 eyes(95.0%)in the silicone oil group(χ^2=0.130,P>0.05).In the air group and the silicone oil group,there were 7 and 2 eyes with subretinal holes,whose retinal reattachmnents were achieved.At 6 months after surgery,logMAR BCVA of the eyes in the air group and the silicone oil group were 0.23±0.23 and 0.37±0.23,respectively.All of them were higher than that before operation(t=-2.410,P<0.001).BCVA in the air group was superior to that in the silicone oil group(P<0.05).The

关 键 词：视网膜脱离/外科学 玻璃体切除术 空气 影响因素分析 

分 类 号：R779.6[医药卫生—眼科]