白内障术后视网膜脱离的危险因素及其行视网膜复位术后视力恢复的相关因素分析

Risk factors of retinal detachment after cataract surgery and of factors related to visual recovery

目的观察并分析白内障手术治疗后视网膜脱离发生的危险因素及行视网膜复位术后患者视力恢复的相关因素。方法采用回顾性分析的方法,选择2013年1月至2014年1月间我院收治的白内障术后视网膜脱离患者48例(48只眼)为研究对象,分析患者白内障手术方式,视网膜脱离特征,针对视网膜脱离情况进行手术,术后随访24个月观察疗效并分析视网膜脱离的危险因素。结果视网膜脱离类型主要为孔源性视网膜脱离,术前77.1%的病例可查到裂孔,视网膜脱离范围在3象限的病例最多,裂孔数多为1个或2个;视网膜一次性复位者45例,成功率为93.75%,3例患者经二次玻璃体手术复位成功;高度近视与白内障术后视网膜脱离间隔时间具有相关性(P<0.05);患者年龄及视网膜脱离后就诊时间与视网膜修补术后复发具有相关性(P<0.05);Nd:YAG激光术与视网膜脱离术后视力提高具有相关性(P<0.05)。结论白内障术后视网膜脱离患者术前裂孔检出率低,经1次手术复位成功率高;Nd:YAG激光术史不利于患者术后视力提高,高度近视患者视网膜脱离时间间隔较短,患者大于76岁者、就诊时间处于6~30 d之间的患者其视网膜脱离手术后复发率更高。

Objective To analyze the risk factors of retinal detachment after cataract surgery, and the related fac- tors for visual recovery. Methods Records of 48 patients （ n = 48 eyes ） from January 2013 to January 2014 who suffered retinal detachment after cataract surgery were reviewed. The cataract surgery method, characteristics of retinal detachment, treatment results surgery were reviewed. Patients were followed up for 24 months. Results The main type of retinal detachment was rhegmatogenous retinal detachment. Porous dehiscence can be found in 77. 1% of the cases. Most retinal detachment occurred in the third quadrant with 1 -2 porous dehiscence. The rate of reattachment was 93.75% with first surgery. High myopia is related with the time after which retinal detachment happened （ P 〈 0. 05 ） ; patient age and the visiting time were related with the recurrence after retinal detachment surgery （ P 〈 0. 05 ） ; Nd： YAG laser posterior capsulotomy was related to the improvement of visual outcome （ P 〈 0. 05 ）. Conclusions The detection rate of porous dehiscence was low in patients with retinal detachment after cataract surgery. Patients with high myopia developed retinal detachment faster. The success rate of one time surgery treatment was high, but patients who were treated with Nd：YAG laser capsulotomy were likely have poorer visual outcome. The recurrence rate is much higher in patients over76 ages or with a visiting time between 16 - 30 days.