巩膜外加压术后出现视网膜下液的危险因素分析及影响  

Logistic regression analysis of risk factors for subretinal fluid after rhegmatogenous retinal detachment repair

作　　者：付燕[1] 张月玲[1] 李丽英[1] 杨娜[1] 冉振龙[1] 顾朝辉[1] Fu Yan;Zhang Yueling;Li Liying;Yang Na;Ran Zhenlong;Gu Zhaohui(Department of Ophthalmology,Baoding No.1 Central Hospital,Baoding 071000,China)

机构地区：[1]河北省保定市第一中心医院眼二科,071000

出　　处：《中华眼科杂志》2021年第6期426-432,共7页Chinese Journal of Ophthalmology

基　　金：保定市科技计划自筹经费项目(1941ZF048)。

摘　　要：目的:探讨巩膜外加压术后视网膜成功复位的孔源性视网膜脱离(RRD)患者出现视网膜下液(SRF)的危险因素和对术后视功能恢复的影响。方法:本研究使用了横断面研究和队列研究设计。收集2016年1月至2017年6月在保定市第一中心医院接受巩膜外加压术后视网膜成功复位的RRD患者104例(104只眼),其中男性58例,女性46例;年龄(45.1±4.9)岁。按患者术后1个月相干光层析成像术(OCT)检查是否可见SRF分为SRF组和对照组,其中SRF组72例,对照组32例。记录患者的年龄、性别、眼别、屈光状态、最佳矫正视力(BCVA)、眼压、晶状体状态、视网膜脱离是否累及黄斑、视网膜脱离的持续时间和范围、视网膜裂孔的位置和数量;术中是否进行了外放液、联合环扎、玻璃体腔注气、前房穿刺放液及硅胶海绵的方向和大小等信息。以单因素分析筛选出有统计学意义的危险因素,采用多因素Logistic回归分析确定SRF的独立危险因素。计数资料的组间比较采用卡方检验或Fisher确切概率法,术后两组不同时间的BCVA比较采用独立样本t检验。结果:术后1个月SRF的发生率为69.2%(72/104)。SRF吸收时间为(10.41±7.32)个月。年龄<40岁(OR=32.860,95%CI为3.636~296.986,P=0.002)、合并高度近视眼(OR=7.229,95%CI为1.217~42.94,P=0.03)、视网膜脱离累及黄斑(OR=357.397,95%CI为29.761~4292.0,P=0.000)是出现SRF的独立危险因素。SRF组和对照组术后1个月BCVA分别为0.71±0.18、0.58±0.11,差异有统计学意义(t=4.047,P<0.01);术后3个月BCVA分别为0.55±0.15、0.43±0.12,差异有统计学意义(t=3.914,P<0.01);术后6个月BCVA分别为0.44±0.16、0.39±0.13,差异无统计学意义(t=1.643,P>0.05);术后12个月BCVA分别为0.37±0.12、0.38±0.12,差异无统计学意义(t=-0.202,P>0.05);末次随访BCVA分别为0.36±0.10、0.35±0.09,差异无统计学意义(t=0.464,P>0.05)。结论:年龄<40岁、合并高度近视眼和黄斑区视网膜脱离是RRDObjective To identify factors associated with persistent subretinal fluid(SRF)after scleral buckling and to evaluate surgical outcomes of patients with primary rhegmatogenous retinal detachment(RRD).Methods Cross-sectional study and cohort study.This study included 104 patients(104 eyes)who underwent scleral buckling for repair of RRD between January 2016 and June 2017.Several statistically significant risk factors associated with SRF were screened out with univariate analysis.Then independent risk factors were determined with multivariate stepwise logistic regression analysis.Examinations were taken preoperatively,at 1,3,6,and 12 months postoperatively,and thereafter every six months.Patients were divided into two groups depending on the presence or absence of persistent SRF on optical coherence tomography at 1 month.Results Persistent SRF occurred in 69.2%(72/104)of patients.In multivariate analysis,younger age(OR=32.860,95%CI=3.636-296.986,P=0.002),high myopia(OR=7.229,95%CI=1.217-42.94,P=0.03)and macula-involving retinal detachment(OR=357.397,95%CI=29.761-4292.0,P=0.000)were associated with persistent SRF.Best corrected visual acuity in patients with SRF at 1 month(0.71±0.18 vs.0.58±0.11;t=4.047,P<0.01)and 3 months(0.55±0.15 vs.0.43±0.12;t=3.914,P<0.01)was worse than that in patients with absence of SRF.Best corrected visual acuity in patients with SRF was 0.44±0.16 at 6 months,0.37±0.12 at 12 months and 0.36±0.10 at the last follow-up,with no significant difference from patients without SRF at the three time points(0.39±0.13,0.38±0.12 and 0.35±0.09;t=1.643,-0.202,0.464;P>0.05).Conclusions RRD patients with younger age,high myopia and macular involvement were more likely to develop persistent SRF after scleral buckling.The presence of persistent SRF slowed visual recovery but did not influence the final visual outcomes.

关 键 词：视网膜脱离 巩膜扣带术 视网膜下液 视敏度 危险因素 

分 类 号：R779.6[医药卫生—眼科]