玻璃体切割手术治疗Eales病严重并发症的随访观察

Serious complications of Eales disease treated by vitrectomy

目的观察玻璃体切割手术（PPV）治疗Eales病严重并发症的效果。方法回顾性分析接受首次PPV治疗的Eales病患者27例30只眼的临床资料。患者中，男性20例，女性7例；年龄15～54岁，平均年龄30．7岁。最佳矫正视力（BCVA）为眼前手动～0.5。根据检查结果将患者分为玻璃体积血组、玻璃体增生机化组、局部视网膜脱离组和广泛视网膜脱离组，分别为3、14、7、6只跟。手术方式为标准PPV，必要时联合巩膜扣带手术、晶状体切除手术、眼内激光光凝、巩膜外冷冻、电凝、增生膜剥离切断、视网膜切开或切除、气液交换、玻璃体腔注射曲安奈德、膨胀性气体及硅油填充。30只眼分别接受1～8次手术，平均手术次数2．4次。手术后随访观察6个月～10年。对比观察治疗前后BCVA、视网膜复位以及并发症发生情况。结果末次随访时，BCVA光感～1．5。其中，BCVA≥0．1者24只眼，占80．0％；0．03者1只眼，占3．3％；数指者1只眼，占3．3％；手动者3只眼，占10．0％；光感者1只眼，占3．3％。BCVA提高者22只眼，占73．3％；不变者2只眼，占6．7％；下降者6只眼，占20．0％。手术前后BCVA比较，差异有统计学意义（t=5．132，P〈0．01）。广泛视网膜脱离组BCVA较其他3组低，差异均有统计学意义（F=4．570，P均〈0．05）；单纯玻璃体积血组视力预后较好，但与玻璃体机化增生组和视网膜局部脱离组比较，差异无统计学意义（P〉0．05）。所有患眼PPV手术后第1天视网膜完全复位。末次随访时，无硅油填允视网膜在位24只眼；患者拒绝手术，局部视网膜脱离1只眼；硅油依赖眼5只眼。出现并发症16只眼，占53．3％。结论玻璃体视网膜手术是治疗Eales病严重并发症的有效手段，手术前存在广泛视网膜脱离的患眼手术后视力预后较差。

Objective To observe the clinical efficacy of vitrectomy on the serious complications of Eales disease. Methods The clinical data of 30 eyes of 27 patients （20 males and 7 females） with Eales disease who underwent vitrectomy were retrospectively analyzed. The age was ranged from 15 to 54 years old, with a mean of 30.7 years. The best corrected visual acuity （BCVA） was ranged from hand movement to 0.5. The patients were divided into the vitreous hemorrhage group （ 3 eyes ）, proliferative vitreoretinopathy group （14 eyes）, local retinal detachment group （7 eyes）, and wide retinal detachment group （6 eyes） according to the results of examinations. The standard pars plana vitrectomy （PPV） were performed and scleral buckling, lensectomy, endolaser, transseleral cryotherapy/cautery, membramc removal, retinotomy, fluid air exchange, intravitreal injection of triamcinolone, gas/oil tamponade can be combined if necessary. Those eyes underwent 1 to 8 times （with a mean of 2.4 times） of surgery. The follow up was ranged from 6 months to 10 years. The BCVA, retinal reattachment, complications before and after surgery was comparatively analyzed. Results At the end of the follow-up, the BCVA was ranged from light perception to 1.5. The BCVA was ≥0.1 in 24 eyes （80.0%）,0.03 in 1 eye （3.3%）, counting finger in 1 eye （3.3%）, hand moving in 3 eyes （10.0%） and light perception in 1 eye （3.3%）. The BCVA improved in 22 eyes （73.3%）, stable in 2 eyes （6.7%） and decreased in 6 eyes （20.0%）. The differences are statistically significant between pre and postoperative BCVA （1= 5. 132, P〈0.01）. The BCVA of wide retinal detachment group was less than other 3 groups （F=4. 570, P-〈0.05） ; while the BCVA of vitreous hemorrhage group, proliferative vitreoretinopathy group and local retinal detachment group was the same（P〈0.05）. Complete retinal reattachment was achieved in all eyes at the next day after PPV. At the end of the follow-up, retina reattached in 24 eyes without silicone oil tamponade, local retinal detachment occurred in 1 eye （the patient refused further surgery） and silicone oil tamponade-dependant retinal reattachment 5 eyes. During the follow-up, 16 eyes （53.3 0%） had developed some complications. Conclusions Vitrectomy is an effective way to cure serious complications of Eales disease. The BACV prognosis of patients with wide retinal detachment is poor.