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.     

影响孔源性视网膜脱离术后视力的因素分析

目的:探讨孔源性视网膜脱离(rhegmatogenous retinalde-tachment,RRD)术后视力的恢复情况及其影响因素。方法:回顾性分析我院眼科2002-01/2007-10期间,以孔源性视网膜脱离为第一诊断并经手术治疗视网膜复位成功的病历资料,共99例102眼。其中采用巩膜外路手术81眼、玻璃体联合视网膜手术21眼。观察RRD患者的发病年龄、视网膜脱离范围、视网膜脱离时间、增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)程度、黄斑状态、屈光状态、裂孔位置、手术前后视力、术后裂孔封闭及视网膜复位情况,用卡方检验对不同年龄、视网膜脱离范围、视网膜脱离时间、PVR分级、黄斑状态及屈光状态的患者术后视力变化情况进行分析,根据结果选择差异有统计学意义的因素进行Spearman等级相关检验。结果:视网膜复位术后视力提高53眼(52.0%),视力不变33眼(32.3%),视力下降16眼(15.7%)。不同PVR分级、黄斑状态、视网膜脱离范围、视网膜脱离时间及年龄的术后视力恢复情况有显著差别(P<0.05),不同屈光状态的术后视力恢复情况无明显差别。对上述因素进行Spearman等级相关检验,发现上述术前因素与术后视力关联程度从大到小为:PVR分级(rs=-0.521,P=0.000)、黄斑是否脱离(rs=-0.446,P=0.000)、视网膜脱离时间(rs=-0.423,P=0.000)、视网膜脱离范围(rs=-0.411,P=0.000)、患者年龄(rs=-0.267,P=0.007)。结论:RRD患者的术后视力恢复与术前PVR分级、黄斑状态、视网膜脱离时间、视网膜脱离范围、年龄有关,其中术前PVR分级、黄斑状态、视网膜脱离时间对术后视力的恢复影响最为显著。     

视网膜脱离巩膜扣带手术后的视力及相关因素

目的:研究孔源性视网膜脱离巩膜扣带手术后的视力恢复情况及其相关因素。方法:对186例巩膜扣带手术后视网膜复位成功的病例进行6～12mo的随访,主要检查矫正视力和眼底。36例视力<0.3的患者行眼底荧光血管造影检查。结果:患者186例手术后视力提高104眼(55.9%),视力<0.3者79眼(42.5%)。影响视力恢复的主要因素是术前视网膜脱离的时间、脱离是否累及黄斑,术后黄斑前膜和黄斑水肿,以及患者年龄等。结论:孔源性视网膜脱离患者应尽早手术治疗,手术中避免过度冷凝和环扎带的过度收缩,减少术后并发症的发生,提高视功能。     

74例孔源性视网膜脱离临床分析

目的 通过对孔源性视网膜脱离(以下简称RRD)的临床分折，了解RRD患者的发病情况及术后视力的影响因素。方法 回顾性分析我院收治的74例RRD患者的临床资料。并用SPSS10．0软件分析包进行统计分折。结果 发病年龄在30岁以上占70．2％；高度近视患者占40．5％；RRD患者的手术成功率达到94．6％，术后视力总体高于术前视力(P＜0．05)，但在黄斑裂孔及脱离、合并脉络膜脱离、玻璃体出血及多发性裂孔患者，术后视力无明显改善(P＞0．05)。术前视网膜脱离范围对术后视力有显著影响，但术后视力同时受到多个因素的影响。结论 RRD在中老年及高度近视患者中发病率较高。目前手术治疗仍是治疗RRD最有效的方法，但在术后功能性视网膜复位上还有待进一步研究。     

黄斑裂孔合并周边裂孔视网膜脱离的治疗分析

目的 探讨黄斑裂孔合并周边裂孔视网膜脱离的手术方法和疗效.方法 对12例(12只眼)黄斑裂孔合并周边裂孔性视网膜脱离进行玻璃体切除术联合巩膜扣带术、显微直视下冷凝术及全氟丙烷气体或硅油注入术.结果 随访6～36个月,视网膜复位良好,周边裂孔封闭,黄斑裂孔闭合,术后视力较术前有明显提高,盲目率有显著性下降(X2=10.971,P=0.001).结论 玻璃体切除联合巩膜扣带术、显微直视下冷凝术及全氟丙烷气体注入术治疗黄斑裂孔合并周边裂孔性视网膜脱离,疗效可靠,具有手术时间缩短及并发症少等优点.     

孔源性视网膜脱离术后黄斑形态和视力的研究

目的 观察孔源性视网膜脱离修复术后黄斑区视网膜形态及术后视力恢复情况并研究影响术后视力的相关因素.方法 收集行玻璃体手术或巩膜扣带术成功复位病例,所有病例病程少于1个月,按术前视网膜脱离是否累及黄斑区进行分类,术前和术后均行眼科常规检查和光学相干断层扫描(OCT)检查,随访半年.结果 共收集孔源性视网膜脱离101只眼,其中脱离累及黄斑区为78只眼.行玻璃体手术为36只眼,巩膜扣带术为65只眼,术后半年内均未发生并发症.术后一个月时复查OCT,在玻璃体手术组和巩膜扣带术组分别有55.56％和72.31％的患眼存在黄斑区视网膜形态异常,其中神经上皮层下积液多见.两种手术方式对术后黄斑区视网膜形态有影响(x2=23.65,P＜0.01).在巩膜扣带术组,术前视网膜脱离是否累及黄斑对术后黄斑区视网膜形态有影响(x2=30.331,P＜0.01),对术后视力提高程度有影响(F =8.150,P＜0.01).结论 视网膜脱离修复术的手术方式对术后黄斑区视网膜形态有影响.行巩膜扣带术病例如术前视网膜脱离累及黄斑,术后出现黄斑区视网膜形态异常的可能性大,术后视力恢复差.     

巩膜扣带术与玻璃体切割术治疗累及黄斑的孔源性视网膜脱离后对黄斑结构改变及视力预后的影响

背景 视网膜脱离患者在成功完成视网膜复位手术后并不能很快恢复视力,其原因目前尚不十分清楚. 目的 比较累及黄斑的孔源性视网膜脱离患者巩膜扣带术和玻璃体切割术后黄斑椭圆体区完整性、黄斑区视网膜神经上皮层下积液的发生率及留存时间,探讨黄斑区视网膜神经上皮层下积液存留对视力预后的影响.方法 回顾性分析2010年1月至2013年1月于北京大学人民医院眼科确诊的孔源性视网膜脱离患者66例66眼的病例资料,按手术方式分为巩膜扣带术组和玻璃体切割术组,记录2个组患者病程、屈光状态、最佳矫正视力LogMAR、有无合并症等,观察黄斑区神经上皮下积液存留时间及黄斑椭圆体区完整性,计算2个组在术后1个月时黄斑区神经上皮下积液的发生率. 结果 术前巩膜扣带术组及玻璃体切割术组间年龄、性别、病程、屈光度及LogMAR视力差异均无统计学意义(均P＞0.05).巩膜扣带术组视网膜下积液平均存留(96±60)d,玻璃体切割术组为(21±6)d,差异有统计学意义(t=7.966,P=0.000).术后1个月时,巩膜扣带术组黄斑区神经上皮下积液发生率为78.6％,大于玻璃体切割术组的12.5％,差异有统计学意义(x2=26.891,P=0.000),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异有统计学意义(t=3.185,P=0.003);术后6个月时,巩膜扣带术组与玻璃体切割术组LogMAR视力比较,差异无统计学意义(t=1.876,P--0.065),巩膜扣带术组黄斑区神经上皮下积液完全吸收患者与未完全吸收患者LogMAR视力比较,差异无统计学意义(t=1.755,P=0.087).视网膜神经上皮下积液吸收后,2个组内黄斑椭圆体区连续患者与椭圆体区缺失患者LogMAR视力比较,差异均有统计学意义(巩膜扣带术组:t=2.555,P=0.015;玻璃体切割术组:t=4.005,P=0.001). 结论 椭圆体区受损程度与视网膜脱离时间有关,而椭圆体区的完整性明显影响患者的视力预后.对于累及黄斑的孔源性视网膜脱离患者,玻璃体切割术后视网膜神经上皮下积液吸收较巩膜扣带术快;视网膜神经上皮下积液的存留延缓视力的恢复,手术方式对最终的视力恢复影响不大.     

巩膜扣带术治疗孔源性视网膜脱离屈光参数的临床观察

目的 观察并比较孔源性视网膜脱离(RRD)患者行巩膜扣带手术前后屈光参数的变化,评估术后最佳矫正视力(BCVA)的影响因素。方法 前瞻性病例研究。32例(32只眼) RRD患者行巩膜扣带术。了解术前、术后1周和术后1个月BCVA、角膜曲率、眼轴长度、前房深度变化情况,评估BCVA、角膜曲率、前房深度、眼轴长度与视力预后的相关性。结果 手术后1周、1个月BCVA、角膜水平曲率、角膜垂直曲率、前房深度较术前均有差异(P <0.05)。手术后1周、1个月BCVA分别与治疗前BCVA成正相关(r=0.685,P=0.000; r=0.395,P=0.025)。结论 RRD患者行巩膜扣带手术后,BCVA和屈光参数均有变化。术前BCVA是影响术后视力恢复的影响因素。     

未发现裂孔的人工晶状体眼视网膜脱离的治疗

目的回顾玻璃体切割联合巩膜扣带术治疗未发现裂孔的人工晶状体眼视网膜脱离的结果。方法5例（5眼）未发现视网膜裂孔的人工晶状体眼视网膜脱离患者应用标准的三通道经睫状体扁平部的玻璃体切割、液-气交换、内引流、眼内激光和巩膜扣带术治疗,术后随访6～12个月,观察术前、术后视力,术后视网膜复位状态及手术并发症。结果所有患眼在施行一次手术后视网膜均获复位,应用对数视力表检查3眼视力增进至少3行,视力不变和减退者各有1眼,后者都有黄斑病变。结论对未发现裂孔的人工晶状体眼视网膜脱离患者联合应用玻璃体切割、液-气交换、内引流、眼内激光和巩膜扣带术治疗,显示有良好的解剖和功能效果。     

单纯孔源性视网膜脱离行微创巩膜外加压术后影响复位和视力的因素分析

目的：探讨单纯孔源性视网膜脱离(RRD)行微创巩膜外加压术后影响复位和视力恢复的相关因素。

方法：收集2014-12/2017-10于我院就诊的初发RRD患者296例296眼作为研究对象,所有患者行微创巩膜外加压术,观察术后视网膜复位率以及BCVA,并对可能影响视网膜复位和视力恢复的因素进行分析。

结果：首次行微创巩膜外加压术后复位成功272眼(91.9%)。围术期影响视网膜复位的因素有裂孔数、视网膜脱离范围以及C1级PVR。随访6mo时,BCVA≥0.4者 196眼(66.2%),BCVA<0.4者 100眼(33.8%)。病程长短、术前BCVA、视网膜脱离范围、黄斑累及与否是影响术后BCVA的危险因素(均P<0.05),术前BCVA是影响术后BCVA恢复的独立危险因素(P<0.05)。

结论：微创巩膜外加压术治疗RRD疗效确切,术后复位率较高,对于RRD患者需早发现早治疗。     

累及黄斑的视网膜脱离术后5a的视功能和光学相干断层扫描的分析

目的:观察累及黄斑区视网膜脱离巩膜扣带术后的黄斑光学相干断层扫描(OCT)图像及术前和术后最佳矫正视力(BCVA)之间的关系的研究。方法:回顾分析5a随访的47例47眼累及黄斑区视网膜脱离患者,并将其分成两组:黄斑脱离≤7d组和>7d组。间接眼底镜行眼底检查,并行TOPCON光学相干断层扫描。结果:患者47例术后5a较术后3mo平均术后BCVA增加1.60±0.02行。≤7d组术后5a的BCVA为0.53,>7d组为0.25,两组之间有显著差异(P=0.008)。≤7d组术后BCVA≥0.4者28例,而>7d组术后BCVA≥0.4者7例(P<0.01)。5a术后随访间接检眼镜检查表明,视网膜脱离均复位。而OCT显示视网膜下液1眼(2%),黄斑区神经上皮层组织堆积1眼(2%),这2例患者术后5a的平均视力只有0.13,明显低于其他45例,术后5a平均BCVA视力为0.54(P=0.025)。术后视网膜较厚组BCVA明显高于视网膜较薄的组,并有统计学差异(P=0.008)。结论:累及黄斑的视网膜脱离时间对术后视力的恢复有很大影响,呈负相关,同时术后视力在较长时间里仍会不同程度的提高,术后视网膜的厚度与术后视力呈正相关性。我们建议对于某些术后复位良好而视力不佳者进行OCT扫描,以便发现视力不佳的原因。本研究对临床预测评估累及黄斑的视网膜脱离复位术后,潜在视功能恢复的情况提供依据。     

Primary repair of retinal detachment with 25-gauge pars plana vitrectomy

PURPOSE: To evaluate 25-gauge pars plana vitrectomy (PPV) for primary repair of rhegmatogenous retinal detachment (RRD). STUDY DESIGN AND PARTICIPANTS: This retrospective, consecutive case series included 42 eyes of 41 patients who underwent primary repair of RRD utilizing transconjunctival 25-gauge PPV without scleral buckling at the Cincinnati Eye Institute from July 2004 through January 2007. METHODS: The medical records were retrospectively reviewed, and the corresponding demographic data, preoperative ophthalmic diagnoses, surgical management, and postoperative course and treatment were recorded. Main outcome measures included single surgery anatomical success, preoperative and postoperative visual acuity, and complications. RESULTS: Most patients had pseudophakic RRD (36 [85.7%] of 42 eyes). The crystalline lens was present in the remaining 6 eyes (14.3%). Of 42 eyes, 28 (66.7%) had macula-on RRD, while 14 (33.3%) had macula-off RRD. Four surgeons contributed to this study, and 25-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and gas tamponade were used in each case. The single surgery anatomical success rate was 92.9% (39 of 42 eyes). For eyes with macula-on RRD, best-corrected visual acuity was 20/50 (0.43 logMAR [logarithm of the minimum angle of resolution]) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.24). For eyes with macula-off RRD, best-corrected visual acuity was 5/200 (1.56 logMAR) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.001). Three eyes required additional surgery for final reattachment. Final reattachment was achieved in 100% of patients (mean follow-up, 8 months). CONCLUSIONS: Twenty-five-gauge PPV with laser retinopexy and gas tamponade is effective for primary repair of RRD. The single operation anatomical success rate is comparable with rates reported for primary vitrectomy with 20-gauge instrumentation, scleral buckling, and combined vitrectomy/scleral buckling.     

Anatomical and functional outcome of surgery of primary rhegmatogenous retinal detachment in high myopic eyes

PURPOSE: To analyse the anatomical and functional outcome of surgery for primary rhegmatogenous retinal detachment (RRD) in highly myopic eyes. METHODS: We retrospectively reviewed the medical records of 111 high myopic patients (111 eyes) with primary RRD treated by scleral buckling or pars plana vitrectomy in a tertiary referral university hospital. The postoperative retinal status and best-corrected visual acuity were recorded. Risk factors including age, refractive error, duration of retinal detachment, preoperative visual acuity, extent of detachment, and intraoperative and postoperative complications were evaluated. Multiple logistic regression analysis was used to determine the independent correlation of each variable on anatomical and functional outcome. RESULTS: Primary surgery resulting in retinal reattachment was achieved in 96 (86.5%) eyes with more than 6 months follow-up (range, 6-60 months). Sixty-eight (61.3%) eyes had postoperative corrected visual acuity 20/50 or more. Postoperative complications in high myopic eyes were variable, and the most common was cataract progression (19.8%). Upon multiple logistic regression analysis, young patients had significantly better anatomical outcome, although the variables including less refraction error, better preoperative visual acuity, scleral buckling procedure, and less surgical intervention showed better functional outcome in our series. CONCLUSIONS: The anatomical outcome of surgery for primary RRD in highly myopic eyes was favourable, and young patients tended to have a higher success rate. Functional outcome was significantly correlated with refractive error, preoperative visual acuity, surgical procedure, and number of vitreoretinal surgery.     

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   

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   

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   

Two-year follow-up study comparing primary vitrectomy with scleral buckling for macula-off rhegmatogenous retinal detachment

PURPOSE: To compare the anatomic and visual outcomes achieved by scleral buckling and primary vitrectomy for the repair of macula-off rhegmatogenous retinal detachment. METHODS: The records were reviewed for a consecutive series of 167 patients (167 eyes) who were initially treated with scleral buckling or pars plana vitrectomy for primary macula-off retinal detachment. Patients were treated between January 1993 and December 1996. After adjustments for preoperative characteristics, data from 102 cases (55 scleral buckle cases and 47 primary vitrectomy cases) were used for the final comparison. There had been a minimum follow-up period of 24 months. RESULTS: No significant differences in single-procedure reattachment incidence (91%), final success incidence (100%) and incidence of postoperative proliferative vitreoretinopathy development (4%) were observed between the two treatment groups. Preoperative visual acuity, preoperative intraocular pressure, and duration of macular detachment were the three best predictors of postoperative visual recovery in both groups. Favorable overall visual recovery was obtained postoperatively, with no significant differences between the two groups throughout the follow-up period. However, in the eyes with poor preoperative visual acuity (<0.1), ocular hypotony (intraocular pressure <7 mm Hg), or prolonged macular detachment (more than 7 days), visual recovery in the primary vitrectomy group was significantly better (P <.05) than in the scleral buckle group from the first postoperative month. CONCLUSION: Both procedures achieved favorable anatomic and visual outcomes in the majority of patients with primary macula-off retinal detachment. Primary vitrectomy may be more effective than scleral buckling for achieving early visual rehabilitation in cases complicated by poor preoperative vision, ocular hypotony, and prolonged macular detachment.     

影响巩膜扣带术视网膜复位及视力恢复因素的临床观察

目的 探讨巩膜扣带术(scleral buckling,SB)治疗孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的疗效以及影响视网膜解剖复位和视力恢复的相关危险因素.方法 回顾性分析2005年1月至2008年12月行sB的RRD患者72例(72只眼).术后随访6-30月,平均(13.96±8.28)月,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.Logistic回归用于分析影响视网膜解剖复位和视力恢复的相关危险因素.结果 在眼底镜和B超检测下视网膜首次复位率为90.28%,最终复位率为97.22%;而光学相干断层扫描(optical coherence tomography,OCT)检测下的视网膜首次复位率为59.72%,最终复位率为77.78%.术后BCVAI>0.3者为62.5%.C1级PVR和多发性裂孔对视网膜复位率有显著影响(P=0.0183、0.0181 ).术前视力、黄斑脱离与否、黄斑脱离时间及PVR的程度对术后视力恢复的影响有统计学意义(P=0.0235、0.0124、0.0325、0.0357). 术后出现葡萄膜炎占13.89%,视物变形占9.72%,增殖性玻璃体视网膜病变(proliferative vitreous retinopathy,PVR)进展占6.94%,黄斑皱褶占6.94%,高眼压占4.17%,复视占2.78%.术后前房深度、眼轴长度、屈光度和散光度的变化较术前差异有统计学意义(P=0.0260、<0.0001、0.0005、0.0018).结论 SB治疗RRD有良好的疗效,但C1级PVR和多发性裂孔会显著增加手术失败的风险.术前视力、黄斑脱离状态和脱离时间及PVR的程度是影响术后视力恢复的重要因素;同时,该手术可导致术后前房深度变浅、眼轴延长、屈光度和散光度向负值偏移.