玻璃体切除术前应用糖皮质激素治疗脉络膜脱离型视网膜脱离的效果分析

Efficacy of preoperative glucocorticoid application on vitrectomy for primary rhegmatogenous retinal detachment with choroidal detachment

目的研究术前糖皮质激素的不同应用途径对孔源性视网膜脱离伴有脉络膜脱离玻璃体切除术后解剖复位的影响。设计回顾性病例系列。研究对象北京同仁医院就诊的伴有脉络膜脱离的孔源性视网膜脱离患者155例(155眼)。方法根据术前糖皮质激素使用情况分为4个组:未应用糖皮质激素(A组)43眼;口服糖皮质激素(B组)42眼;球旁注射糖皮质激素组(C组)32眼;玻璃体注射曲安奈德组(D组)38眼。所有患者均为首次行玻璃体切除手术。观察术后6个月视网膜解剖复位的情况。主要指标首次玻璃体切除术后视网膜复位情况。结果首次玻璃体切除术后,A组视网膜复位27眼,手术治愈率62.79%;B组视网膜复位37眼,手术治愈率88.10%;C组视网膜复位29眼,手术治愈率90.63%;D组视网膜复位34眼,手术治愈率89.47%。A组术后视网膜复位率与其他组比较均有统计学意义(P均<0.05);B、C、D三组间比较无明显统计学意义(P>0.05)。结论对于伴有脉络膜脱离的孔源性视网膜脱离,术前应用糖皮质激素可以提高术后视网膜复位率;口服、球旁和玻璃体注射不同糖皮质激素应用方式,对于玻璃体切除术后视网膜复位率无明显差异,可根据患者全身及局部情况进行选择。

Objective To study the effect of preoperative glueocortieoid application on anatomical reduction of rhegmatogenous retinal detachment associated with choroidal detachment （RRDCD） after vitrectomy. Design Retrospective case series. Participants 155 cases （155 eyes） diagnosed as RRDCD were enrolled. Methods The patients were divided into 4 groups according to preoperative glucoeortieoid use： 43 eyes without glucoeorticoid （group A）; 42 eyes with oral glueocorticoid （group B）; 32 eyes with glucocorticoid peribulbar injection （group C）; and 38 eyes with triameinolone acetonide intravitreal injection （group D）. All patients underwent vitreetomy for the first time. The retinal anatomic reattachment was observed 6 months after operation. Main Outcome Measures The retinal reattachment after vitrectomy. Results After vitrectomy, retinal reattached in 27 eyes （62.79%） in group A, 37 eyes （88.10%） in group B, 29 eyes （90.63%） in group C, and 34 eyes （89.47%） in group D. There were significant differences between group A and the other three groups （all P〈0.05）, while no significant difference was found among B, C and D groups （all P〉0.05）. Conclusion For patients with RRDCD, preoperative eortieosteroids can improve the rate of retinal reattachment. No significant difference was found in successful rate of retinal reattaehment after vitrectomy, no matter oral administration, peribulbar injection or intravitreal injection of different glucocorticoid was applicate. Suitable modes of administration and glucocorticoids types could be chosen for patients according to the sys- temic and ocular conditions.