玻璃体切除术联合巩膜扣带术治疗伴玻璃体牵引的孔源性视网膜脱离的临床效果  

Clinical efficacy of vitrectomy combined with scleral buckling for rhegmatogenous retinal detachment with vitreous traction

作　　者：马佳佳[1] 李秋明[1] 鹿晓燕[1] 杨洁 Ma Jiajia;Li Qiuming;Lu Xiaoyan;Yang Jie(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2023年第1期11-16,共6页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省医学科技攻关项目(2018010003)。

摘　　要：目的观察玻璃体切除术、空气填充联合节段性巩膜扣带术治疗伴玻璃体牵引的孔源性视网膜脱离的临床效果。方法回顾性病例系列研究。纳入2020年2月至2022年2月于郑州大学第一附属医院收治的伴玻璃体牵引的孔源性视网膜脱离患者101例(101只眼),所有患者均接受玻璃体切除术、空气填充联合节段性巩膜扣带术治疗。术后随访6个月,对单次手术视网膜复位情况、术后最佳矫正视力(BCVA,logMAR)及并发症进行分析。结果单次手术实现视网膜解剖复位94只眼,占93.07%(94/101);首次手术后复发视网膜脱离7只眼,占6.93%(7/101)。再次行玻璃体切除术伴硅油填充治疗后视网膜复位率为100.00%。不同术眼视网膜裂孔大小和裂孔数量的视网膜复位率比较,差异有统计学意义(χ^(2)=10.55,7.15;P=0.005,0.018)。手术前和术后6个月BCVA分别为1.27±0.93、0.43±0.35,差异有统计学意义(t=9.82,P=0.001)。相关性分析结果显示,手术后BCVA和术前BCVA呈正相关(r=0.40,P<0.001)。术前BCVA(P=0.024)、黄斑区脱离(P=0.001)和视网膜脱离范围(P=0.036)是术后视力不良即末次随访BCVA(logMAR)>0.3的相关因素。结论玻璃体切除术、空气填充联合节段性巩膜扣带术治疗伴有玻璃体牵引的孔源性视网膜脱离可获得较高的视网膜复位率、良好的视力且术后并发症少。Objective To observe the clinical efficacy of pars plana vitrectomy and air tamponade combined with segmental scleral buckling for the treatment of rhegmatogenous retinal detachment with vitreous traction.Methods This was a retrospective case series study.A total of 101 eyes of 101 patients of rhegmatogenous retinal detachment with vitreous traction admitted to the First Affiliated Hospital of Zhengzhou University from Feb.2020 to Feb.2022 were collected.All patients received pars plana vitrectomy and air tamponade combined with segmental scleral buckling.These patients were followed up for 6 months after operation.Single surgical retinal reattachment,postoperative best corrected visual acuity(BCVA,logMAR)and complications were analyzed.Results The single-surgery retinal reattachment was successful in 94 eyes,accounting for 93.07%(94/101);retinal detachment occurred again in 7 eyes(6.93%,7/101)after the first operation.After pars plana vitrectomy with silicone oil tamponade,the final retinal reattachment rate was 100.00%.The rate of reattachment was statistically significant in the size and the number of the hole(χ^(2)=10.55,7.15;P=0.005,0.018).The BCVA before operation and at 6 months after operation were 1.27±0.93 and 0.43±0.35,the difference was statistically significant(t=9.82,P=0.001).Correlation analysis results showed that BCVA after operation was positively correlated with BCVA before operation(r=0.40,P<0.001).Variables associated with postoperative BCVA(logMAR)>0.3 at the last follow-up were preoperative BCVA(P=0.024),macular detachment(P=0.001)and the range of retinal detachment(P=0.036).Conclusion For rhegmatogenous retinal detachment with vitreous traction,pars plana vitrectomy and air filling combined with segmental scleral buckling can achieve higher retinal reattachment rate,good visual effect and fewer postoperative complications.

关 键 词：玻璃体切除术 视网膜脱离 巩膜扣带术 玻璃体牵引 视网膜裂孔 黄斑区 术后视力 视网膜复位 

分 类 号：R779.6[医药卫生—眼科]