孔源性视网膜脱离术后外层视网膜结构的恢复情况及其影响因素  

Related factors of outer retinal recovery after retinal reattachment for macular-off rhegmatogenous retinal detachment

作　　者：翟晶 陈淼 方伟 ZHAI Jing;CHEN Miao;FANG Wei(Opthalmology and Optometry Center,Hangzhou Branch of the Affiliated Eye Hospital of Wenzhou Medical University,Hangzhou 310016,China)

机构地区：[1]温州医科大学附属眼视光医院(浙江省眼科医院)杭州院区视光诊疗中心,310016 [2]海盐县人民医院眼科

出　　处：《浙江医学》2022年第4期374-379,共6页Zhejiang Medical Journal

基　　金：温州市科技计划项目(Y20180717)。

摘　　要：目的观察累及黄斑区的孔源性视网膜脱离(RRD)患者术后外层视网膜结构的恢复情况,并分析其影响因素。方法选取2019年3月至2021年3月在温州医科大学附属眼视光医院杭州院区诊断为累及黄斑区的RRD并经手术成功复位患者84例(84眼),通过频域光学相干断层扫描(SD-OCT)观察术后12个月时黄斑区视网膜椭圆体区和外界膜结构的恢复情况。通过单因素和多因素logistic回归分析黄斑区视网膜椭圆体区和外界膜结构的恢复与黄斑区脱离时间、RRD范围、增生性玻璃体视网膜病变程度、眼轴长度、后巩膜葡萄肿、脉络膜脱离、内层视网膜病变、手术方式、玻璃体腔有无硅油填充、有无人工晶状体等因素之间的关系。结果84例患者椭圆体区完整恢复39例(46.43%),外界膜完整恢复34例(40.48%)。单因素分析显示,眼轴长度、后巩膜葡萄肿、内层视网膜病变、玻璃体腔硅油填充与椭圆体区完整恢复均有关(均P<0.05),黄斑区脱离时间、RRD范围、眼轴长度、后巩膜葡萄肿、内层视网膜病变、玻璃体腔硅油填充与外界膜完整恢复均有关(均P<0.05)。多因素logistic回归分析显示后巩膜葡萄肿、内层视网膜病变、玻璃体腔硅油填充均是影响RRD术后椭圆体区和外界膜完整恢复的危险因素(均P<0.05)。结论对于累及黄斑区的RRD患者,存在后巩膜葡萄肿、内层视网膜病变及玻璃体腔硅油填充可能是其复位手术后椭圆体区和外界膜结构恢复欠佳的危险因素。Objective To evaluate the reconstruction of ellipsoid zone and external limiting membrane,and to reveal related factors for their integrity after retinal reattachment of macular-off rhegmatogenous retinal detachment(RRD).Methods From March 2019 to March 2021,84 patients with macular-off RRD undergoing successful retinal repair surgery were enrolled from the Hangzhou Branch of the Affiliated Eye Hospital of Wenzhou Medical University.The changes of ellipsoid zone and external limiting membrane measured by spectral domain optical coherence tomography were recorded.The factors related to outer retinal recovery,including the duration and range of macular-off RRD,degree of proliferative vitreoretinopathy,axial length,posterior sclera staphyloma,choroidal detachment,disorganization of retinal inner layer,silicone oil tamponade,and intraocular lens implantation were analyzed by using univariate and multivariate analyzing methods.Results Eighty-four patients(84 eyes)were enrolled in the study.Thirty-nine cases(46.43%)had their ellipsoid zone fully reconstructed and 34 cases(40.48%)had their external limiting membrane fully reconstructed at 12 months after surgery.The axial length,posterior sclera staphyloma,disorganization of retinal inner layer,and silicone oil tamponade were significantly related with the reconstruction of ellipsoid zone(all P<0.05).The duration of macular detachment,the range of RRD,the axial length,posterior sclera staphyloma,disorganization of retinal inner layer,and silicone oil tamponade were significantly related with the reconstruction of external limiting membrane(all P<0.05).Logistic regression analysis showed that posterior sclera staphyloma,disorganization of retinal inner layer,and silicone oil tamponade were negatively related to the fully reconstruction of ellipsoid zone and external limiting membrane(all P<0.05).Conclusion After successful retinal reattachment for macular-off RRD,the risk factors for the fully reconstruction of ellipsoid zone and external limiting membrane might include

关 键 词：孔源性视网膜脱离 光学相干断层扫描 椭圆体区 外界膜 

分 类 号：R779.6[医药卫生—眼科]