影响巩膜扣带术视网膜复位及视力恢复因素的临床观察

Objective To discuss the effect of treatment of rhegmatogenous retinal detachments (RRD) by scleral buckling surgery as well as the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Methods Seventy-two patients (72 eyes) with RRD treated by scleral buckling surgery in our hospital during January 2005 to December 2008 were retrospectively analyzed. Patients were followed up for 6 to 30 months, an average of (13.96± 8.28) months, and observed the rate of postoperative retinal anatomic reattachment, the best corrected visual acuity (BCVA) and complications. The Logistic regression was used to analyze the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Results Retinal reattachment was achieved in 90.28% after initial surgery and the final success rate for anatomic reattachment was 97.22% assessed with ophthalmoscope and B-mode ultrasonography. But the first and final retinal reattachment rates assessed with the optical coherence tomography (OCT) were 59.72% and 77.78% respectively. Postoperative BCVA =0.3 reached to 62.5%. Retinal reattachment was affected by Grade Cl PVR and multiple breaks (P=0.0183 and P=0.0181, respectively). Preoperative visual acuity , macular detachment status and time, as well as the grade of PVR affected visual recovery significantly (P =0.0235, P =0.0124, P=0.0325 and P=0.0357, respectively). The complications included uveitis (13.89%), dysmorphopsia (9.72%), proliferative vitreous retinopathy (6.94%), macular pucker (6.94%), ocular hypertension (4.17%) and diplopia (2.78%). After SB, the anterior chamber depth, axial length, re fraction and astigmatism were all changed significantly (P=0.0260, P<0.0001, P=0.0005 and P=0.0018, re spectively) than before. Conclusions Scleral buckling is an effective technique for managing RRD, but grade Cl PVR and multiple breaks are significant risk factors for anatomic failure. Preoperative visual acuity, macular detachment status and time, as well as the grade of PVR affected visual recovery significantly. Simultaneously, the surgery could make anterior chamber depth decrease and axial extension. The refractive and astigmatic changes after buckling surgery were negative shifted.     

影响巩膜扣带术视网膜复位及视力恢复因素的临床观察

Objective To discuss the effect of treatment of rhegmatogenous retinal detachments (RRD) by scleral buckling surgery as well as the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Methods Seventy-two patients (72 eyes) with RRD treated by scleral buckling surgery in our hospital during January 2005 to December 2008 were retrospectively analyzed. Patients were followed up for 6 to 30 months, an average of (13.96± 8.28) months, and observed the rate of postoperative retinal anatomic reattachment, the best corrected visual acuity (BCVA) and complications. The Logistic regression was used to analyze the relative risk factors affecting the anatomical retinal reattachment and visual recovery. Results Retinal reattachment was achieved in 90.28% after initial surgery and the final success rate for anatomic reattachment was 97.22% assessed with ophthalmoscope and B-mode ultrasonography. But the first and final retinal reattachment rates assessed with the optical coherence tomography (OCT) were 59.72% and 77.78% respectively. Postoperative BCVA =0.3 reached to 62.5%. Retinal reattachment was affected by Grade Cl PVR and multiple breaks (P=0.0183 and P=0.0181, respectively). Preoperative visual acuity , macular detachment status and time, as well as the grade of PVR affected visual recovery significantly (P =0.0235, P =0.0124, P=0.0325 and P=0.0357, respectively). The complications included uveitis (13.89%), dysmorphopsia (9.72%), proliferative vitreous retinopathy (6.94%), macular pucker (6.94%), ocular hypertension (4.17%) and diplopia (2.78%). After SB, the anterior chamber depth, axial length, re fraction and astigmatism were all changed significantly (P=0.0260, P<0.0001, P=0.0005 and P=0.0018, re spectively) than before. Conclusions Scleral buckling is an effective technique for managing RRD, but grade Cl PVR and multiple breaks are significant risk factors for anatomic failure. Preoperative visual acuity, macular detachment status and time, as well as the grade of PVR affected visual recovery significantly. Simultaneously, the surgery could make anterior chamber depth decrease and axial extension. The refractive and astigmatic changes after buckling surgery were negative shifted.     

巩膜扣带术后影响视网膜复位和视力恢复的相关因素分析

目的 分析孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)行巩膜扣带术后影响视网膜复位和视力恢复的相关因素,为临床治疗提供参考.方法 回顾性临床研究,选择2012年1月至2016年1月我院收治的初发RRD患者行巩膜扣带术治疗者148例148眼,观察术后视网膜解剖复位率、最佳矫正视力(best-corrected visual acuity,BCVA)及并发症,并对可能影响术后视网膜复住和视力恢复的相关因素进行Logistic回归分析.结果 检眼镜和眼底照相检查示首次手术视网膜复位率为91.9％,最终复位率为97.3％;频域光学相干断层扫描(spectral-domainoptical coherence tomography,SD-OCT)检查视网膜首次复位率为60.1％,最终复位率为80.4％.单因素Logistic回归分析结果表明:多发视网膜裂孔和C1级增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)对视网膜复位率有显著影响(均为P＜0.05);单因素Logistic回归分析结果显示:术前BCVA、病程长短、视网膜脱离范围、黄斑累及与否对术后BCVA恢复均有明显影响(均为P＜0.05),而年龄、术前屈光状态、PVR分级、术中是否实施视网膜下放液、玻璃体内注气、联合巩膜外加压、术后视网膜下液对术后BCVA的恢复均无明显影响(均为P＞0.05);多因素Logistic回归分析结果显示:术前BCVA是影响术后BCVA的独立危险因素(P＜0.05).结论 巩膜扣带术治疗RRD效果良好,但多发视网膜裂孔和C1级PVR会增加手术失败风险;术前视力、病程长短、视网膜脱离范围、黄斑状态均影响巩膜扣带术后视力的恢复,而术前视力是关键因素,提示RRD患者应早发现、早治疗,尽可能保护术前视力.     

影响巩膜扣带术后视功能恢复因素的临床观察

目的:探讨孔源性视网膜脱离行巩膜扣带术后,影响其视力恢复的相关因素。方法:回顾性分析孔源性视网膜脱离患者102例102眼,均行一次巩膜扣带术成功治疗视网膜脱离。术后随访3～6mo,观察术后最佳矫正视力,χ2检验用于分析影响视力恢复的相关因素。结果:黄斑是否脱离、术前最佳矫正视力、视网膜脱离范围及术中是否行视网膜下放液均与术后最佳矫正视力相关(P<0.01)。黄斑脱离在1wk内与1wk以上术后视力恢复差异有统计学意义(P<0.05)。结论:黄斑是否脱离及脱离时间、术前最佳矫正视力、视网膜脱离范围和术中放液是影响术后视力恢复的重要因素,术前应详细分析病情,术中尽可能避免行视网膜下放液。     

巩膜扣带术治疗孔源性视网膜脱离

目的 观察巩膜扣带术治疗孔源性视网膜脱离的疗效。方法 160例（168眼）行巩膜扣带术，术中均在双目间接检眼镜直视下定位裂孔、冷凝封闭裂孔。术后随访，观察视网膜复位情况。结果 本组病例初次手术视网膜解剖复位率94．0％。二次巩膜扣带术后视网膜解剖复位率为97．6％。结论 巩膜扣带术是治疗孔源性视网膜脱离的有效方法。合理联合视网膜下液引流、玻璃体气体填充及眼底激光光凝可提高手术成功率。     

巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:观察巩膜扣带术治疗孔源性视网膜脱离的效果。方法:孔源性视网膜脱离患者94例96眼,术中直视下定位、冷凝视网膜裂孔。91眼行巩膜表面节段性外加压,其中37眼联合环扎术,另5眼单纯行环扎术。67眼进行了视网膜下液引流术,19眼在手术结束时行玻璃体腔气体充填。结果:90眼单次手术视网膜解剖复位,首次手术复位率94%,4眼再次手术后复位,手术最终解剖复位率98%。术中及术后无严重并发症发生。结论:巩膜扣带术治疗孔源性视网膜脱离安全有效。     

巩膜扣带术后黄斑区光学相干断层扫描与视力预后的分析

目的 对累及黄斑区的孔源性视网膜脱离行巩膜扣带术手术成功眼后极部进行OCT扫描,并分析其与术后视力的关系.方法 28例28只眼视网膜脱离已累及黄斑区者,经间接检查眼镜下巩膜外加压术联合或不联合环扎术,视网膜均成功复位,分别于术后1周、1、3、6、12个月行最佳矫正视力、眼底照相、光学相干断层扫描(OCT)检查,并进行统计分析.结果 最佳矫正视力提高2行以上者于术后1周、3月、6月、12月分别为53.57％、60.71％、78.57％、85.71％、88.46％,最佳矫正视力(BCVA)术后1周视力较术前明显提高(P=0.001),术后1月与术后1周差异无统计学意义(P=0.124);术后3月与术后1月差异有统计学意义(P=0.033);术后6月与术后3月差异无统计学意义(P=0.206);术后12个月与术后6个月差异无统计学意义(P=0.243),但与术后3个月差异有统计学意义(P=0.011).OCT扫描测量黄斑区神经上皮层厚度+视网膜下液高度于术后1周、1月、3月、6月、12月分别为(507.89±144.37)μm、(389.89±104.47)μm、(298.15±97.35)μm、(264.00±82.26)μm、(230.57±58.71)μm;术后1月与1周(P=0.000)、术后3月与1月(P=0.000)、术后6月与3月(P=0.001)差异均有统计学意义,而术后6月和12月则无明显变化(P=0.088).视网膜神经上皮下积液,随着时间的延长,积液不断吸收,至术后12月时达92.31％视网膜神经上皮下积液完全吸收.结论 OCT能清晰地显示视网膜脱离术后黄斑区微观形态结构的变化,黄斑区解剖复位需要较长时间,可以较好地解释术后视力的恢复过程.     

首选个体化巩膜扣带术治疗孔源性视网膜脱离的临床观察

目的:探讨首选个体化巩膜扣带术治疗孔源性视网膜脱离的临床效果。方法:回顾分析92例95眼孔源性视网膜脱离伴增生性玻璃体视网膜病变C1级以下的病例,根据裂孔位置、数目、视网膜脱离的形态等首选放液或者不放液的巩膜扣带术,个别病例辅以玻璃体腔注气术。随访时间7～48(平均10.2)mo。结果:视网膜一次手术复位成功90眼(95%),视力由术前的4.03±0.42到术后的矫正视力4.58±0.33。结论:首选个体化巩膜扣带术治疗孔源性视网膜脱离能够用最小量的手术、最小的创伤,获得较高的视网膜复位率和较好的视功能。     

视网膜脱离巩膜扣带手术的历程与新动向

1929年开始视网膜脱离手术以来,有关视网膜脱离手术治疗迅猛发展。寻找并且封闭所有的裂孔是手术的基本原则。本综述回顾了视网膜脱离巩膜扣带手术的发展以及各种手术的主要优点和不足。同时对巩膜扣带术与玻璃体手术的复位率、预后视功能及并发症进行比较,讨论视网膜脱离手术治疗的发展趋势。     

三维OCT分析累及黄斑的视网膜脱离巩膜扣带术后黄斑微结构与视力的关系

目的:探讨波及黄斑区的孔源性视网膜脱离(RRD)行巩膜扣带手术前后黄斑区三维光学相干断层扫描图像(3D-OCT)特征,分析其与视力的相关性。方法:回顾性系列病例,30例30眼波及黄斑区的RRD行巩膜扣带术治疗的临床资料,在术后2d,2wk,1、3、6mo随诊时双眼均行3D-OCT检查,观察椭圆体带(EZ)、外界膜(ELM)、黄斑区视网膜下液高度(SRFH)、黄斑中心凹视网膜厚度(CRT)的变化,分析其与术后最佳矫正视力(BCVA)的关系。结果:术前,术后2d,2wk,1、3、6mo SRFH、CRT、BCVA均有差异(P<0.01),术后SRFH、CRT都有不同程度降低,术后BCVA都有不同程度升高,组内两两对比:除SRFH(2wk vs 1mo,P>0.05)、CRT(2d vs 2wk,P>0.05)、BCVA(2d vs术前,2wk vs术前,P>0.05)无统计学意义外,其余各项间的比较均有统计学意义(P<0.05)。EZ、ELM形态可分为:A:EZ和ELM均连续(EZ+ELM+),9眼;B:EZ断裂和ELM连续(EZ-ELM+),7眼;C:EZ连续和ELM断裂:EZ+ELM-,6眼;D:EZ和ELM均断裂(EZ-ELM-),8眼,术后6mo上述4种类型的BCVA分别为0.15±0.04、0.50±0.06、0.54±0.05、0.59±0.09(F=87.210,P<0.05),两两比较:除C vs B和C vs D差异无统计学意义(P>0.05)外,其余各组间的比较差异均有统计学意义(P<0.05)。术后2d的SRF发生率为87%,术后6mo仍有46.6%患者存在持续性SRF。术后CRT与术后SRFH具有正相关关系。结论:巩膜扣带术后黄斑微结构呈动态改变,SRF影响可能表现为BCVA延迟恢复,随着SRF缓慢吸收,CRT逐渐降低,BCVA逐渐升高;ELM或EZ连续提示有较好的BCVA,而ELM断裂可能提示视觉质量更差。     

孔源性视网膜脱离成功复位后中心凹形态与视力的关系

目的 评价孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)巩膜扣带术后黄斑中心凹形态与最佳矫正视力(Best-corrected visual acuity, BCVA)的关系.方法 回顾性连续病例观察研究.对象为73例(73只眼)RRD患者,男39例(53.4％),女34例(46.6％),平均年龄(46.6±11.2)岁,均行巩膜冷凝扣带术成功视网膜复位.其中孔源性视网膜脱离累及黄斑者48只眼,未累及黄斑者25只眼.术后利用SD-OCT (spectral domain-optical coherence tomography)扫描患眼后极部视网膜评估黄斑中心凹的结构.评价患者成功术后中心凹形态与BCVA的关系.结果 SD-OCT扫描发现术后黄斑中心凹视网膜异常眼59只眼(80.8％).黄斑中心凹持续视网膜下液者47只眼(64.4％),黄斑前膜16只眼(21.9％),视网膜水肿11只眼(15.1％),感光细胞内外节(IS/OS)连接中断或消失33只眼(45.2％).31只眼视网膜下液全部吸收,平均吸收时间(5.8±2.6)个月.其中IS/OS连接中断或消失均出现在术前视网膜脱离累及黄斑眼中.伴有视网膜下液、黄斑前膜和视网膜水肿眼的术后最佳矫正视力与无上述视网膜异常眼之间差异无统计学意义.术后最佳矫正视力IS/OS连接完好眼显著优于IS/OS连接中断或消失眼(P ＜0.001).Logistic回归分析显示患者中心凹IS/OS连接形态显著影响术后最佳矫正视力(r=0.835,P＜0.001),其余中心凹异常未见显著影响.结论 孔源性视网膜脱离巩膜扣带术后,视网膜下液吸收缓慢,约需6个月.术后感光细胞层内外节形态与术后视力显著相关,其异常形态可能为术后视力不全恢复的决定性因素.     

巩膜扣带手术后视物变形的原因分析

目的 探讨巩膜扣带手术后视网膜复位患者视物变形的原因。 方法 对巩膜扣带手术后视网膜成功复位的79例79只眼行临床观察，手术后2周、2、6个月及1年时行Amsler表检查，分为视物变形组和无视物变形组；同时行检眼镜、荧光素眼底血管造影（FFA）和光相干断层扫描（OCT）检查。并对手术后2周视物变形10只眼和正常人10只眼行视盘-中心凹角测量。 结果 79只眼手术后2周51只眼（64.56%）视物变形，视物变形眼和正常眼的视盘-中心凹角无明显差异(P=0.880)。79只眼中44只眼(视物变形组35只眼，无视物变形组9只眼) 手术后2周时检查OCT和FFA ，视物变形组OCT发现黄斑结构异常31只眼(88.57%)，有7种类型，主要为神经上皮层脱离（74.29%）；FFA发现黄斑结构异常6只眼(17.14%)，也主要为神经上皮层脱离(66.67%)。无视物变形组OCT发现神经上皮层脱离和色素上皮层脱离各1只眼，FFA未见异常。手术后2、6个月、1年时随访，各有18只眼（18/28）、5只眼(5/9)和3只眼(3/7)异常黄斑结构好转，视物变形减轻或消失；而黄斑前膜形成后未见明显变化，视物变形严重而持续。 结论 巩膜扣带手术后视物变形的主要原因是黄斑结构异常，手术后早期和晚期视物变形的主要原因分别是神经上皮层脱离和黄斑前膜。（中华眼底病杂志，2004，20：94-97）     

累及黄斑的视网膜脱离巩膜扣带术后中心凹显微结构及视力变化

目的 应用高清频域光学相干断层扫描(SD-OCT)~察累及黄斑的视网膜脱离扣带术前后黄斑中心凹的显微结构变化,评估其对术后最佳矫正视力(BCVA)的影响.方法 回顾性研究分析22例一次性手术成功的累积黄斑的视网膜脱离患者的资料,术前及术后1月,3月应用SD-OCT观察中心凹显微结构变化,测量黄斑脱离高度及外核层(ONL)厚度.结果 22例患者术后1月13例(59%)有黄斑下积液.发病年龄、术前ONL厚度与术后BCVA不相关,而病程、术前视力、黄斑脱离高度、脱离范围、术后ONL厚度及术后有无黄斑积液均与术后BCVA显著相关(P=0.046,0.0001.0.0007,0.036.0.01 1.0.002).术后有黄斑积液眼与无黄斑积液眼术后视力差异有统计学意义(u=25,P相似文献   

Electroretinogram changes after scleral buckling surgery of retinal detachment

Objective To observe changes in visual function after a single scleral buckling surgery for rhegmatogenous retinal detachment (RD) by using ERG (electroretinogram). Methods One eye from 56 patients with rhegmatogenous RD was chosen. Forty-three corresponding normal fellow eyes from these patients were chosen as controls. Single scleral buckling surgery was carried out and a full-field ERG was performed before the surgery, and 1 and 6 months after surgery. Results The mean amplitude of ERG decreased and the latency (except for the a-wave) was delayed in the eye with a retinal detachment, and wavelets of the oscillatory potential decreased or were completely lacking. One month after surgery, the amplitudes of the a and b waves were noticeably improved (except for the 30 Hz flicker responses), but the latency (except for the a-wave) was still delayed. The ratio of b/a (mixed response) increased 1 month after surgery, with no further changes thereafter. The amplitude of the scotopic b wave was 58.1% of the control eyes, while the 30 Hz flicker responses was only 45.8% of controls; the difference between the two responses was significant (P < 0.001). The number of oscillatory potential wavelets increased, but the total amplitude of the oscillatory potentials did not exhibit any obvious changes during the follow-up period (P = 0.20). In the 41 patients whose detachment involved the macula preoperatively, the amplitude of the 30 Hz flicker responses improved significantly after surgery (P = 0.037). Six months after the operation, the wave amplitudes were not significantly different from 1 month after surgery, but there was a tendency toward a decrease in the latency. Conclusions After reattachment of the retina, visual function showed dramatic improvement 1 month after the surgery. The postreceptoral responses recovered more than the a-wave. The rod system recovered more quickly and completely than the cone system during the follow-up period. The incomplete recovery observed by using ERGs indicates that there is irreversible damage that likely occurs following retinal detachment and surgery.     

孔源性视网膜脱离伴黄斑脱离巩膜扣带术后影响视力的因素分析

背景巩膜扣带术是治疗孔源性视网膜脱离（RRD）的主流手术之一,近年来随着手术技巧的改进,视网膜的复位率逐渐提高,术后视功能的恢复仍是备受关注的问题。目的分析RRD伴黄斑脱离患者巩膜扣带术后影响视力的因素。方法对116例116眼行巩膜扣带术的RRD伴黄斑脱离患者的临床资料和随访资料进行回顾性分析,按不同年龄、病程的长短、术前视力及视网膜裂孔情况、视网膜裂孔的位置与数目、视网膜脱离的范围及隆起度、手术过程中是否放液、玻璃体腔是否注气等分别分组后进行∥检验,并将确定的统计量与术后视力进行Logistic多因素线性回归分析,分析年龄、术前视力、病程、屈光度等多种因素与术后视力预后的关联情况。结果χ^2检验结果表明,不同的术前视力、病程长短对术后视力预后的影响差异均有统计学意义（P=0．002,P=0．009）;Logistic多因素回归分析发现,术前视力是影响术后视力恢复的独立危险因素（P=0．009）,术前视力与术后视力预后有线性相关关系（r=0．400,P=0．000）,术前视力≥0．05的患者术后视力恢复至0．4的可能性是术前视力〈0．05患者的3倍（OR=2．992）。本组患者病程≤7d、术前视力〉0．05者行巩膜扣带术后视力预后较好。结论RRD伴黄斑脱离患者行巩膜扣带术后影响视力恢复的主要因素为术前视力和病程,提示RRD伴黄斑脱离时应在7d内早期手术,最晚不宜超过10d,以免影响视功能的恢复。