玻璃体手术并发周边部视网膜裂孔的危险因素及预后分析

目的 探讨玻璃体手术并发周边部视网膜裂孔的危险因素及其治疗预后.方法 回顾性系列病例研究.回顾性分析玻璃体手术前不伴有视网膜裂孔或视网膜脱离的379例(404只眼)患者临床资料.对手术中或手术后发现周边部视网膜裂孔的患者,记录裂孔的部位、数量、发现时间及是否伴有视网膜脱离,比较术中或术后发现裂孔的两组患者的治疗方法和视网膜复位率.采用SPSS 10.0统计学软件进行数据分析.增生性糖尿病视网膜病变(PDR)组与视网膜分支静脉阻塞(BRVO)组患者周边部视网膜裂孔的发生率比较,采用χ2检验;两组患者年龄比较,采用t检验;以P＜0.05作为差异有统计学意义.结果 404只眼中,有32只眼出现55个周边部视网膜裂孔,平均发生率7.9%.周边部视网膜裂孔发生率在BRVO组最高(13.3%),而在PDR组的发生率较低(3.7%),两组间差异有统计学意义(χ2=9.18,P＜0.01).55个裂孔中,有51个(92.7%)裂孔发生在有巩膜切口的象限,其中29个裂孔(52.7%)位于手术者主操作手一侧.手术中发现裂孔组的视网膜复位率高于手术后发现裂孔组的视网膜复位率.结论 玻璃体手术并发周边部视网膜裂孔主要与巩膜切口相关,但BRVO也是其危险因素之一.手术中发现裂孔组的视网膜复位率高于手术后发现裂孔组.

Risk factors and prognosis of peripheral retinal breaks complicating pars plana vitrectomy

Objective To assess the risk factors and prognosis of peripheral retinal breaks complicating pats plana vitrectomy.Methods Retrospective observational cage series.Four hundred and four consecutive vitrectomies pedormed on eyes without preexisting retinal breaks or retinal detachments were retrospectively reviewed.Cases with peripheral retinal breaks found during or after the vitrectomy were recorded and analyzed.Results Of the 404 vitrectomies,32 eyes had 55 iatrogenic peripheral retinal breaks with an average incidence of 7.9%.Peripheral retinal breaks were most common in csses with branch retinal vein occlusion (BRVO) (13.3%) and less common in proliferative diabetic retinopathy (PDR) (3.7%) (χ2=9.18,P＜0.01).Of the 55 breaks,51(92.7%) occurred around the sclerotomy sites,and 29(52.7%) in the quadrant corresponding to the predominant hand of the surgeon. Cases with breaks detected during surgery had a better outcome of retinal reattachment as compared with cases identitied postoperatively.Conclusions Peripheral retinal breaks complicating pans plana vitrectomy is mainly sclerotomy-related and is more common in cases with BRVO than in cases with PDR. Early detection during surgery tends to have a better outcome.