影响裂孔性视网膜脱离患者巩膜扣带术后复位的玻璃体相关危险因子(英文)

Risk factors for the diaplastic vitreous after scleral buckling in patients with rhegmatogenous retinal detachment

背景: 增殖性玻璃体视网膜病变是裂孔性视网膜脱离手术失败最主要的原因。已知多种危险因子与其有关, 也有报道增殖性玻璃体视网膜病变A、B 级患者手术后增殖性玻璃体视网膜病变加重。但对于玻璃体动态性变化所起的危险作用较少讨论。目的: 分析影响裂孔性视网膜脱离病例巩膜扣带术后复位的玻璃体相关危险因子, 以期提高手术成功率。设计: 回顾性分析。单位: 暨南大学医学院深圳眼科中心, 深圳市眼科医院眼底病科。对象: 选择 1990- 01/1999- 12 在深圳市眼科医院眼底病科行巩膜扣带术的增殖性玻璃体视网膜病变 B 级裂孔性视网膜脱离患者 440 例 449眼, 均签署知情同意书。方法: 应用三面镜检查与 B 型超声波扫描观察患者玻璃体情况及其与视网膜裂孔、视网膜的关系。观察分析玻璃体变化影响手术成功的危险因子。玻璃体病变与玻璃体后脱离经 B 型超声波扫描确认。玻璃体病变程度分为 5 组: 正常玻璃体组、玻璃体液化组、玻璃体浓缩组、玻璃体牵引组及玻璃体混合性病变组。玻璃体后界膜变化分为 3 组: 无玻璃体后脱离组, 不完全性玻璃体后脱离组及完全性玻璃体后脱离组。视网膜脱离复位≥ 6 个月为解剖复位成功。主要观察指标: ①手术视网膜复位成功率。②视网膜脱离解剖复位失败的危险因子。结果: 连续随访 6 个月以上及病历记录、临床观察资料符合要求者 426例 435 眼。①巩膜扣带术后 394 眼(90.6%) 首次手术视网膜复位; 再次手术成功 39 眼, 总计 433 眼(99.5%) 视网膜复位。平均随访(41.1±18.3)个月。②玻璃体状态中与视网膜脱离解剖复位失败有关的危险因子包括玻璃体浓缩、玻璃体牵引以及 2 种或 2 种以上的混合性状态。③玻璃体与视网膜界面的关系中与视网膜脱离解剖复位失败有关的危险因子包括不完全性玻璃体后脱离和完全性玻璃体后脱离。结论: 玻璃体状态与玻璃体后界面变化是影响裂孔性视网膜脱离巩膜扣带术复位成功的危险因子, 手术前了解其改变很重要。

BACKGROUND： Proliferative vitreoretinopathy （PVR） is the more significant risk factor for anatomic failure of rhegmatogenous retinal detachment （RRD） surgery. It has been known that several risk factors are connected with it, and PVR grade A or B can deteriorate it postoperatively. The predictive risk factor is still progressively evaluated between vitreous status or posterior vitreal cortex and retial interface. OBJECTIVE： To identify the clinical risk factors of dynamic change for anatomic failure in conventional RRD surgery in patients with PVR grade B in Chinese patients. DESIGN： A retrospective analysis. SETTINGS： Shenzhen Ophthalmic Center, Medical College of Jinan University; Department of Eye Fundus, Shenzhen Eye Hospital. PARTICI PANTS： This study was a retrospective review of a consecutive series of 449 eyes of 440 patients （318 males, 122 females） admitted to the Department of Eye Fundus, Shenzhen Eye Hospital, who underwent conventional scleral buckling procedures for RRD with PVR grade B by this group doctors. All the surgery was performed by the same surgeon between January 1990 and December 1999. Informed consents were obtained from all the participants. METHODS： Preoperative and postoperative ophthalmic examination and surgery were performed by the same surgeon. Detailed drawings of findings in vitreous and fundus were routinely obtained with the use of both binocular indirect ophthalmoscope and three-mirror contact lens. The vitreous and PVD status were documented with B-scan ultrasonography. The vitreous status was categorized in five groups： normal vitreous, vitreous liquefaction, vitreous condensation, vitreous traction and combined vitreopathy group （combination of liquefaction, condensation and traction）. The PVD status was categorized into three groups： absence of PVD, incomplete PVD and complete PVD. Retina anatomic reattachment for 6 months or more could be successful. MAIN OUTCOME MEASURES ： ①Successful rate of retina anatomic reattachment; ②Risk factors for anatomic failure of conventional scleral buckling procedures. RESULTS ： Totally 426 patients （435 eyes） were continually followed up for 6 months or more, and their clinical symptoms, correct detail recorded were obtained. ① Anatomic reattachment of the retina was achieved in 394 eyes （90.6%） after a single surgery and in 433 eyes （99.5%） after a second surgery, with a mean follow-up period of （41.1± 18.3） months （range from 6 to 93 months）. ② Factors in the vitreous status predictive of anatomic failure were vitreous condensation, vitreous traction and combination vitreopathy （P 〈 0.05）. Factors in the PVD status predictive of anatomic failure were incomplete PVD and complete PVD （P 〈 0.05）. CONCLUSION ： Preoperative identification of the vitreous and PVD status is important as they are the risk predictors for the anatomic failure in conventional scleral buckling RRD surgery.