原发性孔源性视网膜脱离玻璃体切除术后视网膜脱离复发的危险因素分析  

Risk factors of recurrence after vitrectomy surgery for rhegmatogenous retinal detachment

作　　者：白俊兴 彭晓燕 朱晓青 Bai Junxing;Peng Xiaoyan;Zhu Xiaoqing(Department of Ophthalmology,Beijing Hua’er Hospital,Beijing 100005,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)

机构地区：[1]北京华尔医院眼科,北京100005 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,北京100730

出　　处：《眼科》2024年第1期35-38,共4页Ophthalmology in China

摘　　要：目的观察玻璃体切除术后复发的原发性孔源性视网膜脱离患者的基线眼部特点,分析其复发的危险因素。设计回顾性病例系列。研究对象2017年1月至2021年12月北京华尔医院行初次玻璃体切除术治疗后复发的孔源性视网膜脱离患者16例(16眼),随机选取同一时期内行初次玻璃体切除术治疗后未复发的孔源性视网膜脱离患者45例(45眼)作为对照组。方法回顾患者的临床资料及眼科检查结果,观察比较两组患者初诊时的临床资料(病程、晶状体状态、裂孔位置、脱离范围、脱离是否波及黄斑、脱离是否波及下方、增生性玻璃体视网膜病变(PVR)分级、眼轴长度、视力、眼压),并记录视网膜脱离复发时间。采用Logistic回归分析玻璃体切除术后视网膜脱离复发的危险因素。主要指标病程、晶状体状态、裂孔位置、脱离范围、脱离是否波及黄斑、脱离是否波及下方、PVR分级。结果单因素分析表明,复发者初诊时视网膜脱离范围广(χ^(2)=10.048,P=0.002)、视力差(χ^(2)=10.678,P=0.001)、裂孔位于下方(χ^(2)=5.972,P=0.045)、视网膜脱离波及下方象限(χ^(2)=5.054,P=0.025)、PVR≥C级(χ^(2)=16.775,P<0.001)。Logistic回归分析表明PVR分级≥C的OR值为8.47(95%CI:1.521~47.163,P=0.015),建立复发性视网膜脱离风险因素的主效应模型Logit(P)=β0(-3.322)+2.136X1(χ^(2)=23.133,P<0.001)。结论PVR≥C级是原发性孔源性视网膜脱离玻璃体切除术后视网膜脱离复发的重要危险因素。Objective To investigate the baseline ocular characteristics of patients with recurrence following vitrectomy for primary rhegmatogenous retinal detachment(RRD)and identify potential risk factors for the recurrence.Design Retrospective case series.Participants 16 patients(16 eyes)with recurrent retinal detachment after initial vitrectomy for RRD at Beijing Hua'er Hospital from January 2017 to December 2021 were selected,and 45 patients(45 eyes)who did not experience recurrence after initial vitrectomy during the same period were randomly selected as the control group.Methods Clinical data and ophthalmic examination results of the patients were analyzed retorspetively.We compared the clinical data at the initial diagnosis(course of disease,lens status,macular involvement,hole location,extent of detachment,inferior involvement,PVR grading,axial length,preoperative visual acuity,preoperative intraocular pressure)between the two groups,and recorded the characteristics in recurrence and follow-up.Logistic regression analysis was used to identify risk factors for recurrent retinal detachment after vitrectomy.Main Outcome Measures Course of disease,lens status,macular involvement,hole location,extent of detachment,inferior involvement,PVR grading.Results Univariate analysis showed that wider extent of retinal detachment(χ^(2)=10.048,P=0.002),poor visual acuity(χ^(2)=10.678,P=0.001),inferior hole location(χ^(2)=5.972,P=0.045),inferior quadrant involvement(χ^(2)=5.054,P=0.025),and PVR≥C grade(χ^(2)=16.775,P<0.001)were associated with recurrence.Logistic regression analysis further indicated that the OR value for PVR grading≥C(X1)was 8.47(95%CI:1.521~47.163,P=0.015).The main effect model for risk factors of recurrent retinal detachment was established as Logit(P)=β0(-3.322)+2.136X1(χ^(2)=23.133,P<0.001).Conclusion C grade or worse PVR is an important risk factor for recurrence of retinal detachment after vitrectomy for RRD.

关 键 词：复发性视网膜脱离 增生性玻璃体视网膜病变 

分 类 号：R779.6[医药卫生—眼科]