空气填充在孔源性视网膜脱离玻璃体切割手术中的临床应用及影响因素分析

Efficacy and impacts of air tamponade combined with vitrectomy in the treatment of rhegmatogenous retinal detachment

目的观察和评价玻璃体切割手术(PPV)联合空气填充治疗孔源性视网膜脱离(RRD)的疗效和安全性,初步探讨其影响因素。方法前瞻性非随机对照研究。2016年11月至2018年12月于南通大学附属医院眼科行PPV治疗的RRD患者110例110只眼纳入研究。患者充分了解病情及手术方式后志愿选择手术方式。其中,空气填充组90例90只眼,硅油填充组20例20只眼。两组患者年龄(t=-0.082)、性别构成比(χ^2=1.538)、眼别(χ^2=0.839)、平均病程(Z=-0.276)、眼压(t=3.669)、眼轴长度(t=0.765)、增生性玻璃体视网膜病变分级(Z=-2.101)、高度近视(χ^2=0.013)、晶状体状态(χ^2=1.275)、logMAR BCVA(t=-0.681)、视网膜脱离范围(t=-0.970)、裂孔位置(χ^2=0.108)和数量(t=0.158)、是否累及黄斑(χ^2=1.791)比较,差异均无统计学意义(P>0.05)。所有患者均行标准经睫状体平坦部三通道25G PPV,玻璃体空气、硅油填充分别为90、20只眼。手术后随访时间为1、3、6个月。对比观察两组患眼首次视网膜复位率、BCVA增加倍率和恢复速率、眼压、中心凹视网膜厚度(CFT)、椭圆体带和交叉结合带的变化以及手术后并发症发生情况。两组间等级资料比较采用秩和检验(Mann-Whitney U),分类资料采用χ^2检验,定量资料采用独立样本t检验。组内不同时间点定量资料比较采用单因素方差分析。结果首次手术后,空气组、硅油组视网膜复位分别为87(96.6%)、19(95.0%)只眼。两组患眼视网膜复位率比较,差异无统计学意义(χ^2=0.130,P>0.05)。空气组、硅油组下方裂孔7、2只眼,均一次手术视网膜复位。手术后6个月,空气组、硅油组患眼logMAR BCVA分别为0.23±0.23、0.37±0.23;均较手术前提高,差异有统计学意义(t=-2.410,P<0.001);空气组患眼BCVA优于硅油组,差异有统计学意义(P<0.05)。空气组、硅油组患眼BCVA增加倍率分别为0.69±0.28、0.48±0.30 logMAR单位,两组间差异有统计学意义(t=-3.225,P<0.05);CFT分别为(226.87±42.30)、(234.83±36.10)μm,两组间差异无统计学意义(t=-0.448,P=0.657);出现黄斑前膜分别为3(3.3%)、3(15.0%)只眼,两组间差异有统计学意义(t=4.319,P=0.038)。空气组、硅油组出现后发性白内障分别为15、4只眼,视网膜下残余积液分别为1、2只眼,视物变形各3只眼。结论空气填充联合PPV能够有效治疗RRD,不仅适用于上方裂孔,也适用于下方裂孔;手术后视力恢复较好,并发症少;视网膜脱离尤其是黄斑脱离的时间是影响预后的重要因素。

Objective To evaluate the efficacy and impacts of air tamponadein treating rhegmatogenous retinal detachments(RRD)including inferior breaks after 25G pars plana vitrectomy(PPV).Methods A prospective non-randomized study.From November 2016 to December 2018,110 RRD patients receiving PPV in the Ophthalmology Department of Affiliated Hospital of Nantong University were included in the study.All the patients choose the operation mode voluntarily after fully understand the condition and operation mode.There were 90 eyes in the air filling group and 20 eyes in the silicone oil filling group.There was no difference of age(t=-0.082),sex ratio(χ^2=1.538),left or right eye(χ^2=0.839),average course of disease(Z=-0.276),intraocular pressure(t=3.669),axial length(t=0.765),grade of proliferative vitreous retinopathy(Z=-2.101),high myopia(χ^2=0.013),lens state(χ^2=1.275),logMAR BCVA(t=-0.681),the scope of retinal detachment(t=0.970),the site(χ^2=0.108)and numbers(t=0.158)of the retinal holes,whether involving macula(χ^2=1.791)between the two groups(P>0.05).At 1,3,and 6 months after surgery,the first retinal reduction rate,BCVA increase rate,visual recovery rate,intraocular pressure,fovea retinal thickness(CFT),ellipsoid and cross sectional area,and the occurrence of postoperative complications in the two groups were observed and compared.Independent sample t test and Chi-squared test,Mann-Whitney U test,and ANOVA were used for data comparision.Results After the first operation,retinal reattachmnents were achieved in 87 eyes(96.6%)in the air group and 19 eyes(95.0%)in the silicone oil group(χ^2=0.130,P>0.05).In the air group and the silicone oil group,there were 7 and 2 eyes with subretinal holes,whose retinal reattachmnents were achieved.At 6 months after surgery,logMAR BCVA of the eyes in the air group and the silicone oil group were 0.23±0.23 and 0.37±0.23,respectively.All of them were higher than that before operation(t=-2.410,P<0.001).BCVA in the air group was superior to that in the silicone oil group(P<0.05).The increase rate of BCVA of the eyes in the air group and the silicone oil group were 0.69±0.28 and 0.48±0.30 logMAR units,respectively(t=-3.225,P<0.05).The CFT of the eyes in the air group and the silicone oil group were 226.87±42.30μm and 234.83±36.10μm,respectively(t=-0.448,P=0.657).In the air group and silicone oil group,posterior cataract was observed in 15 and 4 eyes,subretinal residual fluid in 1 and 2 eyes,and visual object deformation in 3 eyes respectively.In the air group and silicone oil group,posterior cataract was observed in 15 and 4 eyes,subretinal residual fluid in 1 and 2 eyes,and visual object deformation in 3 eyes respectively.Conclusions Air filling combined with PPV can effectively treat RRD,which is suitable for both superior and inferior holes.The visual acuity recovered well and the complication is less.The time of retinal detachment(especially the time of macular detachment)is an important factor affecting the prognosis.