儿童孔源性视网膜脱离的临床特征和手术疗效分析

目的探讨儿童孔源性视网膜脱离的临床特征和手术疗效。方法为系列病例研究。对近10年首诊眼科≤14岁的33例（36只眼）儿童孔源性视网膜脱离患者临床资料进行回顾性分析。结果33例（36只眼）中,男性26例（78．8％）,女性7例。患儿首诊年龄中位数为12岁。双侧孔源性视网膜脱离10例（30．3％）;合并对侧眼异常22例（66．7％）。31只眼（86．1％）具有至少1种发生孔源性视网膜脱离的危险因素。有眼部钝挫伤史13只眼（36．1％）,合并先天性或发育性眼部结构异常11只眼（30．6％）,有高度近视和其他内眼手术史者各7只眼（19．4％）,合并眼后节炎性反应3只眼（8．3％）。术前发生黄斑脱离28只眼（77．8％）。随诊时间中位数为12个月。每只眼经历1～5次手术,平均1．9次。最终随诊时,硅油仍然在位4只眼,29只眼（90．6％）视网膜复位。预示术后视力差的因素：术前视力为手动或更低（P=0．001）,黄斑脱离（P=0．003）,增生性玻璃体视网膜病变≥C级（P=0．000）,需要行玻璃体切除术（P=0．002）和使用硅油（P=0．005）。结论有眼部钝挫伤史和先天性或发育性眼部结构异常是儿童孔源性视网膜脱离最常见的危险因素。现代玻璃体视网膜手术能使大多数患儿视网膜复位。预示患儿术后视力差的因素与成人相同。对具有发生孔源性视网膜脱离危险因素的儿童应定期随诊。（中华腰科杂志,2008,44：20-24）

Clinical features and surgical outcomes of children with rhegmatogenous retinal detachments

OBJECTIVE: To describe the clinical features and surgical and visual outcomes in a series of children with rhegmatogenous retinal detachments (RRD). METHODS: Retrospective case series of pediatric patients (14 years old or younger) with RRD who underwent primary surgery at a tertiary referral center between May 1995 and May 2006. Patients with perforating ocular trauma were excluded. RESULTS: Thirty-six eyes of 33 patients were included in this study. The median age was 12 years, and 26 patients (78.8%) were male. Bilateral RRD was present in 10 patients (30.3%); 22 patients (66.7%) had some form of bilateral ocular pathology. At least one predisposing factor could be identified in 31 (86.1%) of eyes examined. Thirteen eyes (36.1%) experienced trauma, 11 eyes (30.6%) had structural abnormalities, high myopia and eyes underwent previous intraocular surgery were 7 (19.4%) each, and 3 eyes (8.3%) had inflammatory fundus disorders. Macular detachment was found in 28 eyes (77.8%). Median follow-up was 12 months. At the end of follow-up for this report, silicone oil was still in place in 4 eyes. Retinal reattachment was ultimately achieved in 29 of the 32 eyes (90.6%) with a mean of 1.9 surgeries per eye, however, visual recovery was modest. Predictors of a poor visual outcome were: hand motions or worse in preoperative vision (P = 0.001), macular-off retinal detachment (P = 0.003), proliferative vitreoretinopathy grade C or worse (P = 0.000), the need for vitrectomy surgery (P = 0.002), and the use of silicone oil (P = 0.005). CONCLUSIONS: Trauma and congenital or developmental anomalies were the most common predisposing factors for pediatric RRD in this series. Retinal reattachment can be achieved in most cases with modern vitreoretinal surgical techniques. Predictors of visual outcomes are similar to those observed in adults. Regular follow-up for children at risk of developing RRD is necessary for early detection.