黄斑脱离型孔源性视网膜脱离患者术后黄斑下积液(SMF)发生的影响因素及SMF对患者视力的影响

Influencing factors of submacular fluid in patients with macula-off rhegmatogenous retinal detachment after surgery and its effect on patients’visual acuity

目的探讨黄斑脱离型孔源性视网膜脱离(RRD)患者术后黄斑下积液(SMF)发生的影响因素及SMF对患者视力的影响。方法选取2020年1月至2021年3月我院收治的黄斑脱离型RRD患者80例(80眼)。所有患者均由同一名经验丰富的眼底病主任医师进行玻璃体切割联合硅油填充术。根据患者术后1个月OCT检查是否发生SMF,将80例患者分为无SMF组(59眼)和SMF组(21眼)。收集两组患者裂孔定位、血清总胆红素含量、中性粒细胞与淋巴细胞比值(NLR)和最佳矫正视力(BCVA)等临床资料。分析两组患者术前和术后3个月血清总胆红素含量、NLR和BCVA的组内和组间差异,寻找SMF发生的影响因素。结果无SMF组患者下方视网膜裂孔引起的RRD发生率低于SMF组,差异有统计学意义(P<0.05)。术后所有患者均达到视网膜解剖复位,观察期(3个月)内未发生硅油填充下视网膜再脱离。术后1个月有6眼SMF自行吸收,剩余21眼仍存在SMF并且持续至术后3个月。术后3个月,有6眼SMF较术后1个月加重。术后3个月,无SMF组患者血清总胆红素含量高于术前,SMF组患者低于术前,无SMF组患者血清总胆红素含量高于同时期SMF组,差异均有统计学意义(均为P<0.05)。术后3个月,无SMF组和SMF组患者NLR均低于术前,无SMF组患者术前和术后3个月NLR均高于同时期SMF组,差异均有统计学意义(均为P<0.05)。SMF组患者术后3个月BCVA较同时间点无SMF组差,各组内患者术后3个月BCVA均好于术后1个月,差异均有统计学意义(均为P<0.05)。二元logistic回归分析结果显示,下方视网膜裂孔是术后SMF发生的危险因素(OR=4.510,P=0.044);术后3个月血清总胆红素含量和NLR是术后SMF发生的保护因素(OR=0.706,P=0.010;OR=0.304,P=0.040)。结论下方视网膜裂孔、术后3个月血清总胆红素含量和NLR是术后SMF发生的影响因素,SMF与氧化应激和炎症有关,SMF对视力的早期恢复是不利的。

Objective To investigate the influencing factors of submacular fluid(SMF)in patients with macula-off rhegmatogenous retinal detachment(RRD)after surgery and its effect on patients’visual acuity.Methods A total of 80 patients(80 eyes)with macula-off RRD admitted to our hospital from January 2020 to March 2021 were selected in the study.They all had pars plana vitrectomy combined with silicone oil tamponade performed by a well-experienced chief physician.According to the SMF shown by Optical Coherence Tomography at 1 month after surgery,these patients were divided into the non-SMF group(59 eyes)and SMF group(21 eyes).Their clinical data,including the location of breaks,serum total bilirubin(STB)level,neutrophil-to-lymphocyte ratio(NLR),and best corrected visual acuity(BCVA),were collected.Differences in the STB level,NLR,and BCVA within and between the two groups were analyzed before and at 3 months after surgery to discover the influencing factors for the occurrence of SMF.Results The incidence of RRD caused by inferior retinal breaks in the non-SMF group was significantly lower than that in the SMF group(P<0.05).All patients had anatomically retinal reattachment after surgery,and there was no re-detachment of the retina under silicone oil tamponade during the three-month observation period.At 1 month after surgery,6 eyes had SMF self-absorbed,while 21 eyes had SMF persisting to 3 months after surgery.At 3 months after surgery,6 eyes had worse SMF than at 1 month after surgery.At 3 months after surgery,the STB level in the non-SMF group was higher than the preoperative level,while in the SMF group,it was lower than the preoperative level,and the STB level in the non-SMF group was higher than that in the SMF group(all P<0.05).NLR in both non-SMF and SMF groups was lower at 3 months after surgery than that before surgery.NLR in the non-SMF group was significantly higher than that in the SMF group before and at 3 months after surgery(both P<0.05).BCVA at 3 months after surgery was better than that at 1 month after surgery in both non-SMF and SMF groups,but BCVA was worse in the SMF group than that in the non-SMF group at the same time point(all P<0.05).Binary logistic regression analysis results showed that the inferior retinal break after surgery was a risk factor for SMF(OR=4.510,P=0.044),while the STB level and NLR at 3 months after surgery were protective factors for SMF(OR=0.706,P=0.010;OR=0.304,P=0.040).Conclusion Inferior retinal breaks,STB level and NLR at 3 months after surgery are influencing factors of SMF postoperatively.SMF is associated with oxidative stress and inflammation,adverse to the early recovery of visual acuity.