不同结膜切口的巩膜外加压术治疗老年孔源性视网膜脱离患者的疗效及其影响因素分析  

Analysis of the efficacy of extra-scleral compression with different conjunctival incisions in the treatment of elderly patients with rhegmatogenous retinal detachment and its influencing factors

作　　者：文勇[1] 王展峰[2] Wen Yong;Wang Zhanfeng(Department of Ophthalmolog,Sixth People's Hospital of Chengdu City,Chengdu,Sichuan,610051,P.R.China;Department of Ophthalmology,Third People's Hospital of Chengdu City,Chengdu,Sichuan,610031,P.R.China)

机构地区：[1]成都市第六人民医院眼科,四川成都610051 [2]成都市第三人民医院眼科,四川成都610031

出　　处：《老年医学与保健》2022年第2期313-317,共5页Geriatrics & Health Care

摘　　要：目的研究巩膜外加压术治疗老年孔源性视网膜脱离患者的疗效,并分析影响术后视力恢复的影响因素。方法研究对象均为成都市第六人民医院于2017年1月—2020年12月收治的老年孔源性视网膜脱离的患者432例(464眼),均采用巩膜外加压术,观察组216例(232眼)接受局部角膜缘基底结膜切口术,对照组216例(232眼)接受角膜缘球结膜切口术。比较2组术后视网膜复位状况及视力恢复状况,并对观察组患者视力恢复影响进行单因素分析及多因素Logistic回归分析。结果观察组的首次复位成功率优于对照组(P<0.05);观察组的术后视力改善率优于对照组(P<0.05);观察组术后不良反应的总发生率低于对照组(P<0.05)。单因素分析表明,具有以下临床特征患者的视力改善率低于其他患者:病程7 d以上、术前视力低于0.4、视网膜脱离范围2象限及以上、累及黄斑(均P<0.05);多因素Logistic回归分析表明,术前视力是影响术后视力改善的独立危险因素(P<0.05)。结论对孔源性视网膜脱落的患者,采用巩膜外加压术有利于降低患者围术期损伤,可高效封闭裂孔、改善视网膜复位与视力恢复的效果。影响患者术后视力恢复水平的主要影响因素是术前视力状况,因此,治疗的关键在于早期诊治。Objective To study the efficacy of extra-scleral compression in the treatment of elderly patients with rhegmatogenous retinal detachment and analyze the influencing factors affecting the recovery of postoperative visual acuity.Methods The research subjects were 432 elderly patients(464 eyes)with rhegmatogenous retinal detachment treated in Sixth People’s Hospital of Chengdu City from January 2017 to December 2020.All of them were treated with extra-scleral compression.216 cases(232 eyes)in the observation group received local corneal rim basal conjunctival incision,and 216 ones(232 eyes)in the control group received corneal rim bulbar conjunctival incision.The postoperative retinal repositioning and visual acuity recovery were compared between the two groups.The influencing factors of visual acuity recovery in the observation group were analyzed by univariate analysis and multivariate logistic regression analysis.Results The success rate of first repositioning in the observation group was higher than that in the control group(P<0.05);the postoperative visual acuity improvement rate in the observation group was higher than that in the control group(P<0.05);the total incidence of postoperative adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Univariate analysis showed that the visual acuity improvement rate of patients with the following clinical characteristics was lower than that of other patients:the course of disease was more than 7 days,the preoperative visual acuity was less than0.4,the range of retinal detachment was more than 2 quadrants,and the macula was involved(all P<0.05).Multivariate logistic regression analysis showed that preoperative visual acuity was an independent risk factor for postoperative visual acuity improvement(P<0.05).Conclusion For patients with rhegmatogenous retinal detachment,extra-scleral compression is helpful to reduce the perioperative injury,effectively close the fissure,and improve the effect of retinal repositioning an

关 键 词：老年 巩膜外加压术 孔源性视网膜脱离 视网膜复位 视力恢复 影响因素 

分 类 号：R779.6[医药卫生—眼科]