近视导致青少年孔源性视网膜脱离的临床特点及手术方式选择

Characteristics and the choice of surgical methods of juvenile rhegmatogenous retinal detachmentcaused by myopia

目的探讨近视导致青少年孔源性视网膜脱离的临床特点及手术方式的选择。方法选取2016年8月1日至2017年8月1日于郑州大学第一附属医院眼科确诊的17～40岁近视导致的孔源性视网膜脱离患者59例（60眼），其中17—28岁26例26眼作为A组，29—40岁33例34眼作为B组，根据患者眼部情况行玻璃体切割术（PPV）或巩膜扣带术（SB）。术后随访至眼部情况稳定，比较分析两组的临床特点、手术方式的选择及术后效果。结果A组视网膜裂孔以圆形孔为主，B组以马蹄形为主，差异有统计学意义（P=0．009）；A组以视网膜下方脱离为主，B组以视网膜全部脱离为主，差异有统计学意义（P=0．000）；A组手术方式以sB为主，B组以PPV为主，差异有统计学意义（P=0．000）；术后两组单次视网膜复位率、最佳矫正视力（BCVA）比较差异未见统计学意义（P〉0．05）。结论对于近视导致的青少年孔源性视网膜脱离，可以通过SB保留液化轻的玻璃体，通过PPV去除液化重的玻璃体。

Objective To investigate the clinical characteristics and the choice of surgical meth- ods for patients with juvenile rhegmatogenous retinal detachment caused by myopia. Methods Fifty-nine patients （60 eyes） with rhegmatogenous retinal detachment caused by myopia, aging 17 to 40 years, con- firmed in Department of Ophthalmology in the First Affiliated Hospital of Zhengzhou University from August 1st 2016 to August 1st 2017 were selected. Of them, 26 patients （26 eyes） aging 17 to 28 years were allocated into group A; 33 patients （34 eyes） aging 29 to 40 years were allocated into group B. Im- plemented pars plana vitrectomy （PPV） or scleral buckling surgery （SB） according to patient＇s eye con- dition. Patients were followed up until eye condition was stable. The clinical features, choice of surgical approach and postoperative results of the two groups were compared and analyzed. Results The retinal breaks were mainly round in group A, and mainly horseshoe - shaped in group B, the difference was sta- tistically significant （P = 0. 009） ; in group A, the inferior retinal detachment was the most, while the complete retinal detachment was the most in group B, and the difference was statistically significant （ P = 0. 000）. Patients in group A were mainly treated by BS, while patients in group B were mainly treated by PPV, the difference between the two groups was statistically significant （P = 0. 000） ; postoperative sin- gle retinal reattachment rate, best corrected visual acuity （BCVA） between the two groups were not sta- tistically significant （P 〉 0. 05 ）. Conclusions For patients with juvenile rhegmatogenous retinal detach- ment caused by myopia, preserving the vitreous by SB is a better method for less liquefied vitreous, and removal of the vitreous by PPV is better for liquefied vitreous.