外伤性视网膜脱离术后复发的临床特征分析

目的探讨外伤性视网膜脱离术后复发的临床特征。 方法收集2013年1月至2018年6月北京同仁眼科中心外伤性视网膜脱离术后复发视网膜脱离的77例(77只眼)病例资料，并进行回顾性分析。其中，男性67例(67只眼)，女性10例(10只眼)；年龄7~64岁，平均年龄(35.0±14.5)岁。根据致伤原因、复发视网膜脱离的时间、玻璃体的状态和视网膜脱离的范围将患者进行分组。采用均数±标准差描述患者年龄分布的情况；采用眼数和百分比描述不同分组的病例数量与病例分布的情况。采用卡方检验比较不同致伤原因导致复发视网膜脱离患者的百分比，以及不同玻璃体状态下，患者视网膜脱离的位置范围与视网膜脱离发生率的差异。 结果术后复发视网膜脱离的患者中，因眼内异物致伤的患者有16例(16只眼)，占20.8%；闭合性眼外伤患者有19例(19只眼)，占24.7%；除眼内异物伤以外的开放性眼外伤患者有42例(42只眼)，占54.5%。经卡方检验，三组患者的差异有统计学意义(χ²＝10.37，P<0.05)；进一步两两比较，闭合性眼外伤组患者和开放性眼外伤组患者与眼内异物伤组患者的差异有统计学意义(χ²＝9.80，7.01；P<0.05)；闭合性眼外伤组与开放性眼外伤组的差异无统计学意义(χ²＝0.90，P>0.05)。患者复发视网膜脱离前的手术次数为1~6次，平均(2.4±0.9)次。视网膜脱离复发发生在前次手术后3个月内的有44例(44只眼)，占57.1%；视网膜脱离复发发生在前次手术后12个月以上的有5例(5只眼)，占6.5%。视网膜脱离复发前，行玻璃体手术的有72例(72只眼)，占93.5%；行巩膜外加压术的有5例(5只眼)，占6.5%。所有患者中，眼内硅油存留的有49例(49只眼)，占63.6%；眼内房水填充的有24例(24只眼)，占31.2%；下方视网膜再脱离的患者有34例(34只眼)，占44.2%；视网膜全脱离的患者有26例(26只眼)，占33.8%。硅油填充眼的患者中，视网膜全脱离的有13例(13只眼)，占26.5%；下方视网膜脱离的有27例(27只眼)，占55.1%。房水填充眼的患者中，视网膜全脱离的有13例(13只眼)，54.2%；下方视网膜脱离的有6例(6只眼)，占25.0%。经卡方检验，差异有统计学意义(χ²＝5.37，5.90；P<0.05)。硅油填充眼的患者中，鼻侧视网膜脱离的有4例(4只眼)，占8.2%；房水填充眼的患者中，鼻侧视网膜脱离的有1例(1只眼)，占4.2%；玻璃体无填充的患者中，鼻侧视网膜脱离的有2例(2只眼)，占50.0%。经卡方检验，差异有统计学意义(χ²＝8.85，P<0.05)。所有患者中，视网膜前或视网膜下存在增生膜的有71例(71只眼)，占92.2%。行再次手术的患者有74例(74只眼)，占96.1%。其中，行玻璃体手术的有71例(71只眼)，占96.0%；行硅油填充术的有67例(67只眼)，占94.4%。术后3~24个月的随访结果显示，再次手术的患者中，视网膜复位的有35例(35只眼)，占47.3%；行硅油填充术的患者中，硅油未取出的有26例(26只眼)，占38.8%。 结论外伤性复发性视网膜脱离的主要原因为增生性玻璃体视网膜病变，玻璃体切除联合硅油填充术是主要的治疗方法，但患者预后不佳。

Clinical study on the causes and characteristics of recurrent retinal detachment after traumatic retinal detachment surgery

ObjectiveTo investigate the causes of recurrent retinal detachment after traumatic retinal detachment surgery and analyze its clinical features. MethodsMedical records of 77 patients (77 eyes) inpatients with recurrent retinal detachment from January 2013 to June 2018 in Beijing Tongren Eye Center were collected and retrospectively analyzed. Males 67 cases (67 eyes), females 10 cases (10 eyes), age 7 to 64 years-old, mean (35.0±14.5) years-old. The patients were divided into groups according to the cause of injury, time of recurrent retinal detachment, vitreous state and extent of retinal detachment. The distribution of age was described by mean±standard. The number and distributions in different groups were described by the number of eyes and percentage. Chi-square test was used to compare the proportion of patients with recurrent retinal detachment among different traumatic causes and differences of incidence in the retinal detachment with vitreous states. ResultsAmong all the patients, intraocular foreign body injury occurred recurrent retinal detachment were in 16 cases (16 eyes), accounting for 20.8%; closed eye trauma occurred recurrent retinal detachment were in 19 cases (19 eyes), accounting for 24.7%; open eye trauma except intraocular foreign body occurred recurrent retinal detachment were in 42 cases (42 eyes), accounting for 54.5%. According to chi-square test, comparison among three groups showed statistically significant differences (χ²=10.37, P<0.05); by after further comparison, there was a statistically significant difference between the closed eye trauma group or the open eye trauma group and the intraocular foreign body injury group (χ²=9.80, 7.01; P<0.05); there was a non-statistically significant difference between the closed eye trauma group and the open eye trauma group (χ²=0.90, P>0.05). Before recurrence of retinal detachment, the number of operations was 1 to 6 (mean 2.4±0.9) times. There were 44 cases (44 eyes), accounting for 57.1%, relapsed retinal detachment occurred within 3 months after the previous operation and 5 cases (5 eyes), accounting for 6.5%, relapsed retinal detachment occurred more than 12 months after the previous operation. Before this recurrent retinal detachment, there were 72 cases (72 eyes), accounting for 93.5%, underwent vitrectomy and 5 cases (5 eyes), accounting for 6.5%, underwent external scleral compression. 49 cases (49 eyes), accounting for 63.6% with silicone oil remained in the eye and 24 cases (24 eyes), accounting for 31.2%, were filled with aqueous humor. 34 cases (34 eyes), accounting for 44.2%, occurred inferior retinal detachment again and 26 cases (26 eyes), accounting for 33.8%, occurred whole retinal detachment again. Among patients with silicone oil-filled eyes, 13 cases (13 eyes), accounting for 26.5%, occurred whole retinal detachment and 27 cases (27 eyes), accounting for 55.1%, occurred inferior retinal detachment; 13 cases (13 eyes), accounting for 54.2%, occurred whole retinal detachment and 6 cases (6 eyes), accounting for 25.0%, occurred inferior retinal detachment. There was a statistically significant difference (χ²=5.37, 5.90; P<0.05). Among patients with silicone oil-filled eyes, 4 cases (4 eyes), accounting for 8.2%, occurred nasal retinal detachment; among patients with aqueous humor filling eyes, 1 case (1 eye), accounting for 4.2%, occurred nasal retinal detachment; among the patients without vitreous filling, 2 cases (2 eyes), accounting for 50.0%, occurred nasal retinal detachment. There was astatistically significant difference (χ²=8.85, P<0.05). 71 cases (71 eyes), accounting for 92.2%, had proliferative membranes in front of or under the retina. 74 cases (74 eyes) accounting for 9.1% underwent reoperation, of which, 71 cases (71 eyes), accounting for 96.0%, performed vitreous surgery and 67 cases (67 eyes), accounting for 94.4%, underwent silicone oil filling. The follow-up visits for 3 to 24 months after operation showed that 35 cases (35 eyes), accounting for 47.3%, had retinal reposition and among patients with silicone oil-filled eyes, 26 cases (26 eyes), accounting for 38.8%, refuse removing the silicone oil. ConclusionsThe main reason for traumatic recurrent retinal detachment is proliferative vitreoretinopathy. Vitrectomy combined with silicone oil filling is the main treatment, which has a poor prognosis.