孔源性视网膜脱离患者玻璃体切割术后黄斑微结构改变对临床结局的评估价值

Evaluation value of macular microstructural changes after vitrectomy for clinical outcomes in patients with rhegmatogenic retinal detachment

目的 分析孔源性视网膜脱离(RRD)患者采用玻璃体切割术(PPV)的临床价值,探讨黄斑微结构改变与临床结局的相关性。方法 选取2020年1月至2022年6月在该院就诊的84例RRD患者作为研究对象,按术后3个月临床疗效评估结果,将患者分为好转组(59例)和未好转组(25例)。比较两组患者性别、年龄、发病时间、RRD波及黄斑情况、眼轴长度、术前最佳矫正视力、术中采用造放液孔情况、视网膜椭圆体带(EZ)缺损≥200μm、EZ完整性、外界膜(ELM)完整性患者占比及外核层厚度。结果 单因素分析结果显示,好转组患者发病时间及术前眼轴长度均短于未好转组,术后早期EZ缺损≥200μm占比低于未好转组,术中采用造放液孔、EZ完整、ELM完整占比均高于未好转组,差异均有统计学意义(P<0.05);两组患者其他指标比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,发病时间≥21 d、眼轴长度≥26.0 mm、术后早期EZ缺损≥200μm占比较高为不良结局的危险因素(P<0.05),术中采用造放液孔占比较高为不良结局的保护因素(P<0.05)。结论 RRD患者采用PPV治疗的整体疗效较好,但术后结局受多种因素影响,发病时间≥21 d、术前眼轴长度≥26.0 mm、术后早期EZ缺损≥200μm可能提示不良预后,诊治期间应高度重视黄斑微结构改变与临床结局之间的关联。

Objective To analyze the clinical value of vitrectomy(PPV)in patients with rhegmatogenous retinal detachment(RRD),and to explore the correlation between macular microstructure changes and clinical outcomes.Methods A total of 84 patients with RRD who were treated in the hospital from January 2020 to June 2022 were selected as the research objects.According to the clinical efficacy evaluation results 3 months after surgery,the patients were divided into improved group(59 cases)and non-improved group(25 cases).The gender,age,onset time,RRD and macular,axial length,preoperative best corrected visual acuity,intraoperative use of liquid drainage hole,the proportion of patients with ellipsoid zone(EZ)defect≥200μm,the integrity of EZ,the integrity of external limiting membrane(ELM),and the thickness of outer nuclear layer were compared between the 2 groups.Results Univariate analysis showed that the onset time and preoperative axial length of the improved group was shoter than those of the non-improved group,the proportion of patients with EZ defect≥200μm in the early postoperative period was lower than that of the non-improved group,the proportion of patients with intraoperative drainage holes,EZ intact,and ELM intact was higher than that of the non-improved group,and the differences were statistically significant(P<0.05).There was no significant difference in other indicators between the two groups(P>0.05).Multivariate Logistic regression analysis showed that onset time≥21 days,axial length≥26.0 mm,and a high proportion of EZ defect≥200μm in the early postoperative period were risk factors for poor outcomes(P<0.05),and a high proportion of intraoperative drainage holes was a protective factor for poor outcomes(P<0.05).Conclusion The overall efficacy of PPV in the treatment of RRD IS good,but the postoperative outcomes are affected by many factors,onset time≥21 days,preoperative axial length≥26.0 mm,and early postoperative EZ defect≥200μm may indicate poor prognosis.During the diagnosis and treatment period,great attention should be paid to the relationship between macular microstructure changes and clinical outcomes.