外伤性视网膜脱离眼发生严重增生性玻璃体视网膜病变的危险因素研究

目的 探讨外伤性视网膜脱离眼发生严重增生性玻璃体视网膜病变(prolifera-tive vitreoretinopathy,PVR)的危险因素.方法 回顾性分析2003年3月至2006年7月我科就诊的开放性眼外伤后视网膜脱离患者43例(43眼),均曾在我科或外院行裂伤缝合手术并存在视网膜裂孔.对性别、年龄、视力和眼压、开放性眼外伤分类、外伤分区、外伤时程、前房出血、晶状体缺如、玻璃体出血、视网膜脱离范围、视网膜下出血、脉络膜脱离性质等行Logistic回归分析,并部分采用χ2检验进行验证.结果 所有开放性眼外伤导致的外伤性视网膜脱离眼均存在一定程度的PVR表现,其中PVR D级所占比例最大(46.5%),46.5%的患眼并不存在明显的前部PVR表现,25.6%患眼4个象限均存在前部增生性改变.Logistic回归分析结果显示:严重PVR危险因素仅视网膜脱离范围和晶状体缺如2项被保留于方程中,其中前者为正相关因素(B=18.853),后者为负相关因素(B=-1.946).严重PVR发生率在年龄<18岁组和年龄≥18岁组分别为41.67%和48.39%(P=0.692),破裂伤组的D级PVR发生率(48.15%)较裂伤组(43.75%)更高,但差异无显著统计学意义(P=0.780).玻璃体出血对严重PVR的影响差异无显著统计学意义(P=0.114),但前房有/无出血组间和视网膜下有/无出血组间差异却有显著统计学意义(P=0.043,0.037).结论 开放性眼外伤导致的外伤性视网膜脱离眼存在特发性PVR特征,视网膜脱离范围和晶状体缺如是影响PVR发生的重要因素,后者为保护性因素.

Risk factors for severe proliferative vitreoretinopathy in eyes with traumatic retinal detachment

Objective To investigate the risk factors for severe proliferative vitreoretinopathy (PVR) in the eyes with traumatic retinal detachment. Methods Fortythree cases (43 eyes) with open traumatic retinal detachment, who had sutured laceration in our department or somewhere else, was with retinal hole, and came to our department from March 2003 to July 2006, were analyzed retrospectively. Logistic regression test was performed at the variates such as gender, age, visual acuity, IOP, types of open ocular trauma, traumatic zones, traumatic duration, hyphema, lens absence, vitreons hemorrhage, retinal detachment quadrants, subretinal hemorrhage and types of choroidal detachment. Chi-Square tests were used partially. Results PVR existed in all the eyes with traumatic retinal detachment caused by open ocular trauma, and PVR at D grade was with the highest percentage about 46.5%. No obvious anterior PVR was found in 46.5% of the eyes. There were anterior proliferative changes at all quadrants in 25.6% of the eyes. Logistic regression test results showed that only retinal detachment quadrants and lens absence were remained in equation to be affecting factors, and the former was positively correlative factor(B = 18.853) and the latter was negatively correlative (B = - 1.946). The rate of severe PVR in age less than 18 years group and age be and more than 18 years group were 41.67% and 48.39% ,respectively (P =0.692). The rate of PVR at D grade was higher in rupture group (48.15%) than that in laceration group (43.75%) ,while which was not statistically significant (P =0.780). The correlation between vitreous hemorrhage and the development of severe PVR was not significant (P=0.114), however,there were significant differences in groups with hyphema or not (P = 0.043) and groups with subretinal hemorrhage or not (P = 0.037). Conclusions Specific PVR characteristics exist in eyes with traumatic retinal detachment caused by open ocular trauma. The retinal detachment quadrants and lens absence are the important affecting factors to the development of severe PVR in traumatic retinal detachment eyes,and the latter is protective factor.