巩膜扣带术治疗青年人孔源性视网膜脱离的疗效分析

Clinical eftlcacy of primary scleral buckling for rhegmatogenous retinal detachment in youths

目的观察巩膜扣带术治疗青年人孔源性视网膜脱离的疗效，分析术后视力的影响因素。方法回顾性系列病例研究。对2011年4月至2015年5月在天津市眼科医院确诊为孔源性视网膜脱离并行巩膜扣带术治疗的91例患者95只眼纳入研究，术中均在双目间接眼底镜直视下进行裂孔定位、适量冷冻，术后随访，观察视网膜复位情况，并在术后3月时记录患者最佳矫正视力。亚组分析青年视网膜脱离患者巩膜扣带术后影响视力的因素，包括年龄、病程、术前最佳矫正视力、黄斑区情况等。结果一次性手术复位率100％，87．3％（83／95只眼）的患眼术后视力提高及稳定不变，术前最佳矫正视力、黄斑状态、病程对术后视力影响差异有统计学意义（P〈0．05）。结论在选定的病例中，巩膜扣带术可以有效治疗青年人孔源性视网膜脱离。术前最佳矫正视力、病程、黄斑状态是巩膜扣带术后影响视力的主要因素，术前最佳矫正视力对其影响最为显著。

Objective To evaluate the anatomical outcomes of primary scleral buckling （SB） for rhegmatogenous retinal detachments in youth, and analyze the factors of influencing the vision follow- ing the surgery. Methods Retrospective case series study. The clinical data of 91 young patients （95 eyes） with rhegmatogenous retinal detachment treated by sclera buckling in the Tianjin Eye Hos- pital from April 2011 to May 2015 were retrospectively reviewed. Localization and cryotherapy of retinal breaks in all eyes were performed with binocular indirect ophthalmoscopy. Retina reattach- ment was observed after the surgery. Best corrected visual acuity （BCVA） at 3 months follow-up was noted. Subgroup analysis was carried out to identify the factors for influencing the vision after the surgery, including age, duration of disease, preoperative best corrected visual acuity, the macular state. Results The success rate was 100%, BCVA was improved or remained in 83 eyes （87.3%）. The influences of preoperative BCVA, the macular state and duration of disease had significant influ- ence on recovery of visual acuity, Conclusions In selected cases, primary SB is an effective treat- ment for rhegmatogenous retinal detachment in youth. The preoperative BCVA, the macular state and duration of disease are important factors influencing the postoperative vision recovery, with the preop- erative BCVA being the most important.