高度近视合并脉络膜脱离型孔源性视网膜脱离预后相关因素分析  

Analysis of prognostic factors in patients with high myopia combined with choroidal detachment retinal detachment

作　　者：贾力蕴 张永鹏 周海英 佘海澄 曹绪胜 高丽琴 马凯 Jia Liyun;Zhang Yongpeng;Zhou Haiying;She Haicheng;Cao Xusheng;Gao Liqin;Ma Kai(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)

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,眼科学与视觉科学北京市重点研究室,100730

出　　处：《眼科》2021年第1期42-46,共5页Ophthalmology in China

摘　　要：目的分析高度近视合并脉络膜脱离型孔源性视网膜脱离(RRD-CD)患者的预后相关因素。设计回顾性病例系列。研究对象2004-2018年北京同仁医院高度近视合并RRD-CD患者占836例。方法回顾北京同仁医院住院HIS系统,收集高度近视合并RRD-CD手术治疗患者临床资料。随访6个月视网膜复位为复位组,发生视网膜再脱离为未复位组。采用Logistic回归法分析视网膜脱离复发的危险因素。主要指标手术成功率及复发危险因素。结果共纳入高度近视合并RRD-CD患者836例,平均年龄(56.51±12.14)岁;男性518例(61.9%),右眼发病434例(51.9%)。视网膜脱离未复位为22.7%,与视网膜复位患者相比,未复位患者年龄较轻,术前视力、眼轴、晶状体状态、视网膜裂孔、增生性玻璃体视网膜病变(PVR)等级及手术方式等差异均有统计学意义,其中年龄〔优势比(OR)=0.972,95%可信区间(95%CI),0.967~0.989〕,术前视力光感(OR=1.898,95%CI为1.297~2.777),人工晶状体眼(OR=1.860,95%CI为1.255~2.758),眼轴>30 mm(OR=1.718,95%CI为1.240~2.379),巨大视网膜裂孔(OR=2.464,95%CI为1.495~4.063)及PVR D级(OR=1.551,95%CI为1.046~2.300)为视网膜脱离未复位的危险因素。结论高度近视合并RRD-CD患者男性比例大,中年发病、超高度近视、人工晶状体眼、巨大视网膜裂孔及PVD D级患者首次手术成功率低,视网膜脱离易复发。(眼科,2021,30:42-46)Objective To analyze the prognostic factors in patients with high myopia(HM)combined with choroidal detachment retinal detachment(RRD-CD).Design Retrospective case series.Participants 836 patients with HM and RRD-CD of Beijing Tongren Hospital from 2004 to 2018.Methods A retrospective chart review was carried out on all patients with HM and RRD-CD having surgical treatment.Recurrence rate was calculated and risk factors of recurrence RRD were analyzed using Logistic regression analysis.Main Outcome Measures Operation success rate,risk factors of recurrence RRD.Results A total of 836 patients with HM complicated with RRD-CD were included,with an average age of 56.51±12.14 years;518 cases(61.9%)were male,434 cases(51.9%)had right eye disease,and 22.7%had retinal detachment without reattachment.Compared with the patients with retinal reattachment,the age of patients without reattachment was younger,and the differences in preoperative visual acuity,axial length,lens state,retinal hole,PVR grade and operation method were statistically significant.Age[odds ratio(OR)=0.972,95%confidence interval(95%CI),0.967-0.989],preoperative visual acuity(OR=1.898,95%CI:1.297-2.777),intraocular lens(OR=1.860,95%CI:1.255-2.758),axial length more than 30 mm(OR=1.718,95%CI:1.240-2.379),giant retinal hole(OR=2.464,95%CI:1.495-4.063)and PVR Grade D(OR=1.551,95%CI:1.046-2.300)was the risk factor for retinal detachment without reattachment.Conclusions High myopia patients with RRD-CD have a large proportion of males.Middle aged patients with ultra-high myopia,intraocular lens,giant retinal hole and PVD grade D have low success rate of the first operation,and retinal detachment is easy to relapse.(Ophthalmol CHN,2021,30:42-46)

关 键 词：高度近视 脉络膜脱离型视网膜脱离 危险因素 

分 类 号：R779.6[医药卫生—眼科]