视网膜脱离巩膜扣带术后持续性黄斑下液患者视力预后的影响因素  

Influencing factors of visual prognosis in patients with persistent submacular fluid after successful scleral buckle surgery for macula-off retinal detachment

作　　者：陈燕云 田蓓 何雷 李蕾 李婧 史翔宇 周丹 Chen Yanyun;Tian Bei;He Lei;Li Lei;Li Jing;Shi Xiangyu;Zhou Dan(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology&Visual Sciences,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、北京市眼科研究所、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼科杂志》2023年第11期899-905,共7页Chinese Journal of Ophthalmology

摘　　要：目的探讨孔源性视网膜脱离(RRD)行巩膜扣带术后持续性黄斑下液(PSF)患者视力预后的影响因素。方法回顾性病例系列分析。收集2020年06月至2022年12月在北京同仁医院行巩膜扣带手术并一次获得成功的RRD患者的病历资料并随访。纳入术前RRD累及黄斑区、增生性玻璃体视网膜病变(PVR)分级为C1级及以下的患者,手术遵循最小量巩膜扣带术设计,术后黄斑区视网膜下液超过1个月即定义为PSF。于术后1 d、3 d、7 d、2周、1个月规律随访,之后每个月随访直至PSF完全吸收。所有患者在术后随访时间点均检查最佳矫正视力(BCVA)、眼压、屈光度数,并行眼前节裂隙灯显微镜检查、双目间接检眼镜眼底检查和相干光层析成像术(OCT)。根据末次随访BCVA是否≥0.5及是否PSF的吸收时间>6个月分别将患眼分为两组,采用Wilcoxon符号秩检验、χ^(2)检验及Mann-WhitneyU检验进行统计学分析。结果46例患者(46只眼)纳入本研究,其中男性25例,女性21例;年龄为32.5(21.0,57.3)岁;术前等效球镜度数为(-5.27±4.05)D,术前病程为30(14,92)d,术前视力BCVA[最小分辨角的对数(logMAR)]为2.00(1.00,2.50)。28只眼(60.9%)行巩膜外加压,18只眼(39.1%)行巩膜外加压联合环扎。15只眼(32.6%)行巩膜外放液,31只眼(67.4%)无巩膜外放液。术后1个月、3个月、末次随访BCVA(logMAR)分别为0.60(0.50,1.00)、0.40(0.28,0.53)、0.15(0.00,0.50)。末次随访BCVA≥0.5的患眼为31只眼(67.4%),OCT视网膜外层椭圆体带连续的患眼26只眼(56.5%)。分别比较术前、术后1个月、术后3个月与末次随访的BCVA(logMAR),差异均有统计学意义(Z=-5.85,-5.63,-4.73;均P<0.001)。术后PSF吸收时间为6.50(3.00,9.00)个月,其中吸收时间最短为2个月,最长为19个月。术后PSF持续时间<3个月、3~6个月、>6个月的患眼分别为12只眼(26.1%)、11只眼(23.9%)、23只眼(50.0%)。术后末次随访BCVA≥0.5组共31只眼,术后末次随访BCVA<0.5Objective To investigate the factors influencing visual outcomes in patients with rhegmatogenous retinal detachment(RRD)who developed persistent submacular fluid(PSF)after scleral buckling surgery.Methods A retrospective case series analysis was conducted.Clinical data were collected from patients who underwent successful scleral buckling surgery for RRD at Beijing Tongren Hospital from June 2020 to December 2022 and were followed up.Patients with RRD involving the macular area preoperatively and graded as C1 or below in proliferative vitreoretinopathy(PVR)were included.Surgical procedures followed a minimally invasive scleral buckling approach.PSF was defined as subretinal fluid persisting for more than 1 month postoperatively.Regular follow-up visits were scheduled at postoperative days 1,3,7,2 weeks,and 1 month,followed by monthly visits until complete PSF absorption.Best-corrected visual acuity(BCVA),intraocular pressure,refractive error,slit-lamp biomicroscopy,binocular indirect ophthalmoscopy,and optical coherence tomography(OCT)were performed at each follow-up time point.Eyes were divided into two groups based on whether the final follow-up BCVA was≥0.5 and whether the absorption time of PSF was>6 months,and statistical analysis was performed using the Wilcoxon signed-rank test,chi-squared test,and Mann-Whitney U test.Results A total of 46 patients(46 eyes)were included in this study,comprising 25 males and 21 females,with a median age of 32.5(21.0,57.3)years.The preoperative equivalent spherical refractive error was(-5.27±4.05)D,and the preoperative duration of illness was 30(14,92)days.The preoperative BCVA(logarithm of the minimum angle of resolution,logMAR)was 2.00(1.00,2.50).Scleral buckle surgery was performed in 28 eyes(60.9%),and 18 eyes(39.1%)underwent scleral buckle surgery combined with encircling.External drainage was performed in 15 eyes(32.6%),while 31 eyes(67.4%)had no external drainage.BCVA(logMAR)at 1 month,3 months,and the final follow-up postoperatively was 0.60(0.50,1.00),0.40(0.28,0

关 键 词：视网膜脱离 巩膜扣带术 手术后并发症 视网膜下液 视敏度 预后 

分 类 号：R779.6[医药卫生—眼科]