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。

Visual prognosis factors analysis of scleral buckling for primary macula-off rhegmatogenous retinal detachment

Background Many surgical techniques are used to improve the postoperative visual acuity for rhegmatogenous retinal detachment(RRD)during recent decade,and scleral buckling surgery is one of these operations.Whether the visual function after operation can be rescued is an important issue. Objective The aim of this study was to analyze the risk factors of influencing the postoperative vision following scleral buckling surgery for primary macula-off RRD. Methods The clinical and follow-up data from consecutive series of 116 eyes of 116 patients received scleral buckling surgery for primary maeula-off RRD were retrospectively reviewed.The relationship of multiple factors,including age,preoperative best corrected visual acuity(BCVA),duration of disease,refractive error,location of retinal hole,number of retinal hole,area and height of retina detachment,management of subretinal fluid and intravitreal gas injection,with visual acuity were analyzed respectively by χ2 test.The correlations among statistically significant factors with postoperative vision were analyzed by multivariate Logistic regression analysis.Written informed consent was obtained from any patient before surgery. Results The postoperative vision outcome was found with significantly difference among different preoperative vision groups(P=0.002)and different course (P=0.009).There were significant differences between the groups with different preoperative BCVA(P=0.002)and duration of disease(P=0.009).Multivariate Logistic regression analysis showed that the preoperative BCVA was the only variable affecting postoperative visual result(r=0.400,P=0.009).Considerable linear correlation wag seen between preoperative vision and postoperative vision(r= 0.400,P=0.000).The probability with postoperative vision of t>0.4 in the eyes with preoperative≥0.05 was 3 folds more than that of preoperative<0.05(OR=2.992).The better visual outcome after scleral buckling surgery was seen in the eyes with the course≤7 days. Conclusion Preoperative BCVA and duration of disease are the key factors associated with the postoperative BCVA.Scleral buckling surgery should be performed within the first week for primary macula-off RRD.