玻璃体切割联合空气填充治疗非下方孔源性视网膜脱离疗效的初步观察

Management of non-inferior rhegmatognous retinal detachment with vitrectomy and air tamponade

目的初步观察玻璃体切割手术(PPV)联合空气填充治疗非下方孔源性视网膜脱离(RRD)的疗效。方法前瞻性病例系列研究。2017年8月至2018年4月在扬州大学附属苏北人民医院眼科行PPV治疗的连续原发性RRD患者39例39只眼纳入研究。其中,男性20例20只眼,女性19例19只眼;右眼23只,左眼16只;平均年龄(55±11)岁。有晶状体眼30只,无晶状体或IOL眼9只;视网膜裂孔1、2、≥3个分别为21、14、4只眼。所有患者均行标准经睫状体平坦部三通道23G PPV。全部切除玻璃体并清除视网膜表面丝状增生膜和玻璃体皮质,裂孔周围激光光凝3~5排,气液交换后关闭穿刺口。手术后随访时间>2个月。观察手术后视网膜复位情况、视力改变及其他并发症情况。手术前后BCVA与病程的相关性采用Pearson相关性分析法;手术后视网膜复位成功率与手术前不同临床因素相关性的比较采用χ2检验。结果手术后2个月时,39只眼中,首次手术后视网膜复位35只眼,占89.8%。首次手术后2~3周视网膜再脱离4只眼,占10.2%;再次给予PPV联合硅油填充后视网膜复位,其中1只眼再次手术后1.5个月时黄斑前膜形成。首次手术后视网膜复位的35只眼,手术前及手术后2个月logMAR BCVA分别为1.15±0.78、0.41±0.31,差异有统计学意义(t=6.589,P=0.000)。相关性分析结果显示,手术后BCVA与手术前BCVA呈正相关(r=0.544,P=0.001)。30只有晶状体眼中,随访期内发生不同程度并发性白内障12只眼。不同视网膜裂孔数患眼视网膜复位率比较,差异有统计学意义(χ2=9.181,P=0.010)。结论PPV联合空气填充治疗非下方RRD具有较高成功率和较好的安全性。

Objective To observe the outcomes of 23G pars plana vitrectomy(PPV)and air tamponade for non-inferior rhegmatognous retinal detachment(RRD).Methods A prospective case series study.From August 2017 to April 2018,39 consecutive RRD patients(39 eyes)in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study.There were 20 males(20 eyes)and 19 females(19 eyes),23 right eyes and 16 left eyes,with the mean age of 55±11 years.There were 30 eyes with lens and 9 eyes without lens or IOL.There were 21,14 and 4 eyes with 1,2 and equal or greater than 3 retinal tear respectively.All patients underwent 23G PPV which performed preretinal proliferative membranes and vitreous cortex removal,photocoagulation around the breaks with 3-5 rows,and filtered air tamponade.The follow-up was more than 2 months.The retinal reattachment,visual acuity and complications were observed.Pearson correlation analysis was used to analyze the correlation between BCVA and disease course.Chi-square test was performed for comparison among retinal reattachment rate and different clinical factors before operation.Results At 2 months after the PPV,35 eyes'retina reattached,the rate of reattachment was 89.8%.In 2-3 weeks,4 eyes were re-detached,all of them performed silicone oil tamponade.One eye was secondary to pre-macular membrane.The logMAR BCVA before and after PPV were 1.15±0.78 and 0.41±0.31,respectively(t=6.589,P=0.0001).Correlation analysis results showed that BCVA after surgery was positively correlated with BCVA before surgery(r=0.544,P=0.001).Twelve of 30 eyes with crystalline lens suffered cataract.The rate of reattachment vary in the number of the breaks(χ2=9.181,P=0.010).Conclusion PPV with air tamponade may be an optimal treatment of non-inferior RRD with better success rate and security.