温州医科大学附属眼视光医院玻璃体切割术适应证及术式10年变化趋势

Trends in Indications and Surgical Techniques for Vitrectomy of the Eye Hospital,Wenzhou Medical University during a Recent Ten-Year Period

目的:探讨温州医科大学附属眼视光医院2010年至2019年间玻璃体切割术适应证及术式的变化趋势。方法:回顾性系列病例研究。纳入2010年1月1日至2019年12月31日在温州医科大学附属眼视光医院行玻璃体切割手术的病例22491例,其中男12287例,女10204例,年龄1~95岁。根据玻璃体切割手术适应证(视网膜脱离、糖尿病视网膜病变、黄斑病变、眼外伤、无视网膜脱离的玻璃体视网膜疾病、晶状体病变及其他眼病)、手术类型(前段玻璃体切割术、单纯玻璃体切割术及玻璃体切割联合晶状体手术)及玻璃体腔填充物(气体、硅油及其他液体)进行分类,对上述适应证、手术方式变化趋势及患者的人口学资料进行统计学描述。结果:温州医科大学附属眼视光医院玻璃体切割术年手术量由2010年的1398例逐渐增加至2019年的3791例。患者年龄由2010年的(50.1±16.4)岁上升至2019年的(57.2±14.5)岁,以男性为多,但女性比例逐年增加(由2010年的39.7%增至2019年的46.6%)。2010年至2019年间,前4位玻璃体切割术适应证依次为视网膜脱离(29.4%),黄斑疾病(22.0%),糖尿病视网膜病变(19.7%)及眼外伤(15.5%)。因黄斑疾病接受手术的患者数量及构成比逐年增多,由2010年的195例(14.0%)增加至2019年的1054例(27.8%),已成为玻璃体切割术的首位适应证。手术类型方面,玻璃体切割联合晶状体手术为13896例(61.8%),所占的比例明显上升(2010年55.2%,2019年69.0%)。玻璃体腔填充物方面,气体及硅油是玻璃体切割术后的主要填充物(2010年占83.4%,2019年占74.9%)。近5年硅油填充比例较前5年下降(2010─2014年期间占40.2%~43.8%,2015─2019年期间占34.1%~39.6%)。结论:2010─2019年温州医科大学附属眼视光医院玻璃体切割手术的主要适应证为视网膜脱离、黄斑疾病、糖尿病视网膜病变。其中黄斑疾病占比逐年增加。玻璃体切割联合晶状体手术已成为主流术式。10年来玻璃体切割术后硅油填充的使用比例在逐渐下降。

Objective:To analyze trends in indications and surgical techniques for vitrectomy in the Eye Hospital,Wenzhou Medical University from 2010 to 2019.Methods:This was a retrospective case series study.22491 patients who underwent vitrectomy,aged from 1 to 95 years,in the Eye Hospital,Wenzhou Medical University were enrolled from January 2010 to July 2019.There were 12287 males and 10204 females.The indications(retinal detachment,diabetic retinopathy,maculopathy,ocular trauma,vitreoretinopathy without retinal detachment,lens lesions and other oculopathies),surgical procedures(anterior vitrectomy,vitrectomy alone and vitrectomy combined with lens surgery)and vitreous substitutes(gas,silicone oil and other liquids)for vitrectomy were collected.Patient demographics,indications and types of vitrectomy performed were evaluated.SPSS 21.0 statistical software was used,mainly for a statistical description of the data.Results:The numbers of annual surgeries performed at the Eye Hospital,Wenzhou Medical University for vitrectomy were 1398 cases in 2010,rising gradually to 3791 cases in 2019.The mean age of patients who underwent vitrectomy was 50.1±16.4 years in the 2010 s,rising gradually to 57.2±14.5 years in the 2019 s.Macular disease in vitrectomy patients had increased rapidly over the ten years.There was a higher proportion of male patients compared to females,while the proportion of females had increased gradually(2010,39.7%;2019,46.6%).Retinal detachment(29.4%),maculopathy(22.0%),diabetic retinopathy(19.7%)and ocular trauma(15.5%)were the top 4 indications for vitrectomy between 2010 and 2019.The number and proportion of patients undergoing vitrectomy for maculopathy increased year by year.Vitrectomies for maculopathy were performed on 195 cases(14.0%)in the 2010 s,and frequency reached 1054 cases(27.8%)in the 2019 s.Maculopathy has become the first indication for vitrectomy.For the type of vitrectomy,13896 cases(61.8%)were vitrectomy combined with lens surgery,which had been increasing since 2010(2010,55.2%;2019,69.0%).In the vitreous substitute of vitrectomy,gas and silicone oil were the main vitreous substitutes after vitrectomy(2010,83.4%;2019,74.9%).The proportion of silicone oil decreased in the latter 5 years(2010 to 2014 ranged from 40.2%to 43.8%;2015 to 2019 ranged from 34.1%to 39.6%).Conclusions:Retinal detachment,maculopathy and diabetic retinopathy from ocular trauma were the leading indications for vitrectomy,and maculopathy increased rapidly in the Eye Hospital,Wenzhou Medical University from 2010 to 2019.Vitrectomy combined with lens surgery is becoming the mainstream procedure for vitrectomy and the proportion of silicone oil used for filling decreased gradually over the 10 years.