影响孔源性视网膜脱离术后视力的因素分析

Influencing factors to postoperative vision in rhegmatogenous retinal detachment

目的:探讨孔源性视网膜脱离(rhegmatogenous retinalde-tachment,RRD)术后视力的恢复情况及其影响因素。方法:回顾性分析我院眼科2002-01/2007-10期间,以孔源性视网膜脱离为第一诊断并经手术治疗视网膜复位成功的病历资料,共99例102眼。其中采用巩膜外路手术81眼、玻璃体联合视网膜手术21眼。观察RRD患者的发病年龄、视网膜脱离范围、视网膜脱离时间、增生性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)程度、黄斑状态、屈光状态、裂孔位置、手术前后视力、术后裂孔封闭及视网膜复位情况,用卡方检验对不同年龄、视网膜脱离范围、视网膜脱离时间、PVR分级、黄斑状态及屈光状态的患者术后视力变化情况进行分析,根据结果选择差异有统计学意义的因素进行Spearman等级相关检验。结果:视网膜复位术后视力提高53眼(52.0%),视力不变33眼(32.3%),视力下降16眼(15.7%)。不同PVR分级、黄斑状态、视网膜脱离范围、视网膜脱离时间及年龄的术后视力恢复情况有显著差别(P<0.05),不同屈光状态的术后视力恢复情况无明显差别。对上述因素进行Spearman等级相关检验,发现上述术前因素与术后视力关联程度从大到小为:PVR分级(rs=-0.521,P=0.000)、黄斑是否脱离(rs=-0.446,P=0.000)、视网膜脱离时间(rs=-0.423,P=0.000)、视网膜脱离范围(rs=-0.411,P=0.000)、患者年龄(rs=-0.267,P=0.007)。结论:RRD患者的术后视力恢复与术前PVR分级、黄斑状态、视网膜脱离时间、视网膜脱离范围、年龄有关,其中术前PVR分级、黄斑状态、视网膜脱离时间对术后视力的恢复影响最为显著。

AIM ：To investigate the postoperative vision in rhegmatogenous retinal detachment（RRD）, and its influencing factors. METHODS： All 99 patients（102 eyes） with RRD that underwent surgical management in our hospital from January 2002 to October 2007 were retrospectively analyzed. 81 eyes underwent surgical management of scleral buckling and 21 eyes underwent surgical management of vitreoretinal surgery. Age, area of retinal detachment, course, proliferative vitreoretinopathy（ PVR）, involvement of the macular region in the detachment, refraction , position of break, visual acuity, situation of the break and its closure on retina and retinal replacement of patients were observed. Chi-square test was performed to analyze the postoperative vision and influencing factors, for example age, area of retinal detachment, course, proliferative vitreoretinopathy （ PVR）, situation of the macular and refraction. According to the results, the significative factors were analyzed with Spearman test. RESULTS： Improved postoperative vision was observed in 53 eyes （52.0%）, invariable vision was observed in 33 eyes（32.3%）, and descended vision was observed in 16 eyes （15.7%）. The situation of postoperative vision had significant difference in different PVR grade, macular situation, area of retinal detachment ,course and age （P〈 0.05）, and the connections between postoperative vision and influencing factors were as follows： PVR grade（ rs =-0. 521, P = 0. 000）, macular situation （ rs = -0. 446, P = 0. 000 ）, course （ rs = -0.423, P = 0.000） ,area of retinal detachment（ rs = -0.411, P= 0. 000） ,age（ rs = -0. 267, P = 0. 007）. CONCLUSION： Postoperative vision improvement was related with PVR grade, macular situation, course, area of retinal detachment,and age, preoperative PVR grade, macular situation, and course are the most important influencing factors to postoperative vision.