影响复杂性外伤性视网膜脱离预后的相关因素

Application of vitrectomy in complicated traumatic retinal detachment

目的探讨复杂性外伤性视网膜脱离的玻璃体手术方法及影响预后的相关因素。方法回顾性分析复杂性外伤性视网膜脱离65例(65眼),均作玻璃体切除术联合晶状体切除、眼内异物摘出、视网膜切开切除及巩膜环扎等附加术式。通过非参数检验(多个独立样本Kruskal-Wallis H检验),按初诊视力、视网膜脱离范围、眼内出血程度、眼内容脱失程度、有无视网膜下出血、黄斑损伤以及外伤类型等不同情况分组,分析各相关因素与预后的关系。结果视网膜总复位率为89.23%(58/65),其中解剖复位30眼(46.15%),功能复位28眼(43.08%),未复位7眼(10.77%)。初诊视力、视网膜脱离范围、眼内出血程度、眼内容脱失程度、有无视网膜下出血或黄斑脱离以及外伤类型等因素对手术结果预后的影响均有统计学意义(P<0.01)。结论多数复杂性外伤性视网膜脱离经玻璃体手术治疗后视网膜仍能解剖复位,部分患眼可功能复位。术前应详细分析病情,多种因素均与伤眼治疗结果密切相关。

Objective To evaluate the efficacy of vitrectomy for complicated traumatic retinal detachment and investigate the risk factors associated with the prognosis. Methods The clinical data of 65 cases with complicated traumatic retinal detachment treated with vitrectomy were reviewed retrospectively. Results The retina was reattached anatomically in 30 eyes （46%）, functionally in 28 eyes（43% ）, and still detached in 7 eyes. We classified the cases in this study into a number of subgroups according to clinic appearance including the initial visual acuity, the extent of retinal detachment, the severity of intraocular hemorrhage and subretinal hemorrhage, loss of ocular content, the type of trauma. Significant correlations associated with prognosis were detected in each subgroups. Conclusions Vitrectomy is useful for complicated retinal detachment. The prognosis of injured eyes with complicated retinal detachment highly correlate to certain clinic appearance such as the initial visual acuity, the extent of retinal detachment, the severity of intraocular hemorrhage and subretinal hemorrhage, the loss of ocular content, the type of trauma.