孔源性视网膜脱离硅油填充患眼硅油乳化情况和相关因素分析

Analysis of silicone oil emulsification and related factors in eyes filled with silicone oil for rhegmatogenous retinal detachment

目的观察孔源性视网膜脱离(RRD)患眼硅油填充手术后硅油乳化情况,初步分析与之相关的可能临床因素。方法横断面临床观察。2019年1月至2022年4月于复旦大学附属眼耳鼻喉科医院行玻璃体切割手术(PPV)联合硅油填充治疗的RRD患者50例50只眼纳入研究。其中,男性25例25只眼,女性25例25只眼;年龄(54.86±11.79)岁。手术后3个月,患眼视网膜均在位。硅油取出手术前眼压>21 mm Hg(1 mm Hg=0.133 kPa)或给予≥1种抗青光眼药物治疗(高眼压)20只眼;眼压≤21 mm Hg且不用抗青光眼药物治疗30只眼(正常眼压)。手术后随访时发现硅油乳化且符合硅油取出适应证者行硅油取出手术。硅油取出后立即收集前2 ml灌洗液,采用Multisizer®3颗粒/细胞计数及粒度分析仪测量其中乳化硅油的颗粒直径和数量。测量范围0.4~12.0μm,并据此将直径分为0.4~<1.0、1.0~<3.0、3.0~<5.0、5.0~<7.0、7.0~12.0μm。每个样本测量3次,取平均值。采用Spearman相关性分析和多元线性回归分析乳化硅油颗粒数与临床因素的相关性。结果乳化硅油颗粒数(1.74±2.94)×10^(7)(0.96×10^(7)~14.11×10^(7)个/ml),其中直径0.4~<1.0μm乳化硅油颗粒为(1.25±2.41)×10^(7)个/ml,占(64.26±12.70)%[(1.25±2.41)×10^(7)/(1.74±2.94)×10^(7)]。相关性分析结果显示,乳化硅油总颗粒数与各临床因素均无相关性(P>0.05)。直径7.0~12.0μm乳化硅油颗粒数与年龄呈负相关(r=-0.298,P=0.036),与眼轴长度呈正相关(r=0.325,P=0.021);不同性别、眼别、硅油填充手术前是否合并眼外伤、脉络膜脱离以及不同晶状体状态均与乳化硅油颗粒数无相关性(P>0.05)。多元线性回归分析结果显示,眼轴(β=1570.868,P=0.023)、年龄(β=-316.128,P=0.039)是硅油乳化为大直径颗粒(7~<12μm)的风险预测因素。高眼压者直径7~12μm乳化硅油颗粒数显著高于正常眼压者,差异有统计学意义(U=195.00,P=0.037)。结论RRD患眼硅油填充手术后眼内乳化硅油颗粒多数为小直径颗粒;年轻患者及长眼轴患者中硅油乳化更严重,年轻患者更容易发生高眼压。

Objective To observe the emulsification of silicone oil in eyes with rhegmatogenous retinal detachment(RRD)after silicone oil filling surgery,and to preliminarily analyze the possible clinical factors related to it.Methods A cross-sectional clinical study.From January 2019 to April 2022,50 eyes of 50 patients with RRD who underwent pans plana vitrectomy(PPV)combined with silicone oil filling surgery in Eye and ENT Hospital of Fudan University were included in the study.Among them,there were 25 males with 25 eyes and 25 females with 25 eyes;the age was 54.86±11.79 years old.The retina was in place 3 months after surgery.Before silicone oil removal surgery,intraocular pressure>21 mm Hg(1 mm Hg=0.133 kPa)or treated with≥1 anti-glaucoma drug(high intraocular pressure)in 20 eyes;intraocular pressure≤21 mm Hg and no anti-glaucoma drug treatment in 30 eyes(normal intraocular pressure).During follow-up after surgery,silicone oil emulsification was found and those who met the indications for silicone oil removal were subjected to silicone oil removal surgery.The first 2 ml of lavage fluid was collected immediately after removal of the silicone oil,and the particle diameter and number of emulsified silicone oil were measured using a Multisizer®3 particle/cell counter and particle size analyzer.The measuring range was 0.4-12.0μm,and the diameter is accordingly divided into 0.4-<1.0,1.0-<3.0,3.0-<5.0,5.0-<7.0,7.0-12.0μm.Each sample was measured 3 times and the average value was taken.Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlation between the number of emulsified silicone oil particles and clinical factors.Results The number of emulsified silicone oil particles was(1.74±2.94)×10^(7)/ml(0.96×10^(7)-14.11×10^(7)/ml),of which the diameter of 0.4-<1.0μm emulsified silicone oil particle was(1.25±2.41)×10^(7)/ml,accounted for(64.26±12.70)%[(1.25±2.41)×10^(7)/(1.74±2.94)×10^(7)].The results of correlation analysis showed that there was no correlation between the total particle number of emulsified silicone oil and various clinical factors(P>0.05).The number of emulsified silicone oil particles with a diameter of 7.0-12.0μm was negatively correlated with age(r=-0.298,P=0.036),and positively correlated with axial length(r=0.325,P=0.021).There was no correlation between the previous ocular trauma,choroidal detachment and different lens states and the number of emulsified silicone oil particles(P>0.05).Multiple linear regression analysis showed that eye axis(β=1570.868,P=0.023)and age(β=-316.128,P=0.039)were the risk predictors of silicone oil emulsification into large diameter particles(7-<12μm).The number of emulsified silicone oil particles with a diameter of 7-12μm in the patients with high intraocular pressure was significantly higher than that in the patients with normal intraocular pressure,and the difference was statistically significant(U=195.00,P=0.037).Conclusions Most of the emulsified silicone oil particles in the eyes of RRD patients after silicone oil filling surgery are small-diameter particles;the silicone oil emulsification is more serious in young patients and patients with long ocular axis,and young patients are more prone to high intraocular pressure.