玻璃体切除联合硅油填充术治疗脉络膜脱离型视网膜脱离的效果  

Efficacy of vitrectomy combined with silicone oil tamponade in the treatment of rhegmatogenous retinal detachment associated with choroidal detachment

作　　者：郑玉宝 李兵 刘军磊 杨旭 Zheng Yubao;Li Bing;Liu Junlei;Yang Xu(Department of Fundus Disease,Nanyang Municipal Eye Hospital,Nanyang 473000,China)

机构地区：[1]南阳市眼科医院眼底病科,南阳473000

出　　处：《中华眼外伤职业眼病杂志》2024年第2期141-148,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察脉络膜脱离型视网膜脱离(RRD-CD)患者行25 G玻璃体切除联合硅油填充术的长期疗效。方法回顾性病例系列研究。分析南阳市眼科医院2017年8月至2022年8月住院行25 G玻璃体切除联合硅油填充术治疗的RRD-CD患者82例(82眼)的临床资料。分析术前与术后最佳矫正视力(BCVA,log MAR)、眼压、眼前段炎症反应及最终视网膜复位率、视网膜脱离复发率。硅油取出术后随访3~48个月。结果术后所有患者脉络膜脱离完全复位。术后随访,发现有9例视网膜脱离复发,并在二次手术取出硅油的同时,再次对局限性视网膜脱离进行对应的复位操作处理。术后随访视网膜脱离复发时间为2~20(12.24±2.36)周,初次手术视网膜解剖复位成功率为89.02%(73/82),有79例患者最终复位,复位率96.34%。复发性视网膜脱离患者共计9例,再次接受手术,最终复位6例,在初次手术后4~9(5.16±1.65)个月行硅油取出术。入院时、术后1周及末次随访时的BCVA分别为2.10(2.10,2.18)、1.00(0.80,1.20)、1.00(0.80,1.00),不同时间BCVA比较差异具有统计学意义(χ^(2)=131.12,P<0.001),术后1周(Z=-7.88,P<0.001)及末次随访(Z=-7.94,P<0.001)与术前相比,差异有统计学意义。入院时、术前、术后1周及末次随访眼压分别为8.00(6.00,9.00)、8.00(6.00,9.00)、16.00(13.00,19.25)、16.00(15.00,17.00)mmHg(1 mmHg=0.133 kPa)。不同时间眼压比较差异具有统计学意义(χ^(2)=202.87,P<0.001),入院时与术前(Z=-1.84,P=0.065)、术后与末次随访(Z=-0.58,P=0.564)差异无统计学意义。入院时与术后1周(Z=-7.75,P<0.001)、入院时与末次随访(Z=-7.89,P<0.001)、术前与术后1周(Z=-7.84,P<0.001)、术前与末次随访(Z=-7.88,P<0.001)比较差异具有统计学意义。患者手术后视力有明显改善,眼压较术前提高。结论25 G玻璃体切除联合硅油填充术治疗脉络膜脱离型视网膜脱离,长期随访结果显示视网膜复位率高、并发症少,是较为安全�Objective To observe the long-term surgical outcomes of patients with rhegmatogenous retinal detachment associated with choroidal detachment(RRD-CD)treated with 25 G pars plana vitrectomy(PPV)combined with silicone oil tamponade.Methods This was a retrospective case series study.The clinical data of 82 eyes of 82 patients who underwent 25 G pars plana vitrectomy combined with silicone oil tamponade from Aug.2017 to Aug.2022 in Nanyang Municipal Eye Hospital were analyzed.Preoperative and postoperative best corrected visual acuity(BCVA,logMAR),intraocular pressure,anterior segment inflammation,final retinal reduction rate,and incidence of recurrent retinal detachment were analyzed.The visit time after silicone oil removal was 3-48 months.Results All patients had completed reduction of choroidal detachment after surgery.In 9 cases,retinal detachment recurred during visit.All patients were treated with silicone oil removal and then retinal detachment was reset.The recurrence time of retinal detachment during visit was 2-20 weeks,with an average of(12.24±2.36)weeks,and the success rate of initial retinal anatomical reduction in the first operation was 89.02%(73/82),and the final retinal reduction was achieved in 79 cases with a reduction rate of 96.34%.Six of the 9 patients with recurrent retinal detachment achieved final reduction after reoperation,and silicone oil was taken out,and the removal time ranged from 4 to 9 months after the initial operation,with an average of(5.16±1.65)months.BCVA at admission,1 week postoperatively,and last visit were 2.10(2.10,2.18),1.00(0.80,1.20),1.00(0.80,1.00),and 1.00(0.80,1.00),respectively.There was a statistically significant difference in BCVA at different time points(χ^(2)=131.12,P<0.001).BCVA was higher before surgery than at 1 week postoperatively(Z=-7.88,P<0.001)and at the last visit after surgery(Z=-7.94,P<0.001).The intraocular pressure at admission,preoperation,1 week postoperatively,and the last visit was 8.00(6.00,9.00),8.00(6.00,9.00),16.00(13.00,19.25),and 16.00(

关 键 词：玻璃体切除术 硅油类 视网膜脱离 脉络膜疾病 

分 类 号：R779.6[医药卫生—眼科]