复发性孔源性视网膜脱离的临床研究

Clinical study on recurrent rhegmatogenous retinal detachment

目的研究孔源性视网膜脱离(RRD)术后复发视网膜脱离(RD)的临床特征及影响因素。方法回顾性病例系列研究。纳入2017年1月至2021年12月就诊于山西省眼科医院的孔源性视网膜脱离术后出现复发性RD者73例(73眼)。所有患者行巩膜扣带术或玻璃体切除术治疗,术中根据情况选择玻璃体腔填充物。术后随访时间至少为最后一次术后3个月,检查患者术后视网膜复位情况、裂孔闭合情况和最佳矫正视力(BCVA,logMAR)等。比较患者基线资料及复发时的临床特征并评估影响患者术后视网膜复位及视力恢复的因素。结果有62例在复发RD后行1次手术,其中7例裂孔未闭合二次复发RD;11例在复发后行2次手术,其中2例裂孔未闭合最终再复发RD。患者术后BCVA为1.20±0.47较术前1.57±0.53明显提高,差异有统计学意义(P<0.001)。回归分析结果显示增生性玻璃体视网膜病变(PVR)≥C级(OR=0.10,95%CI:0.01~0.95,P=0.045)和下方RD(OR=6.00,95%CI:1.02~35.31,P=0.048)是RRD术后复发RD的重要相关因素。在复发性RD中黄斑孔是影响术后视力恢复的主要因素(OR=0.02,95%CI:0.01~0.02,P=0.016)。RD复发持续时间与最终BCVA呈正相关(r=0.31,P=0.008)。结论RRD患者术后复发RD者行手术治疗后仍然有RD再次复发的风险。PVR≥C级和下方RD与RRD手术后复发性RD的发生率密切相关。

Objective To study the clinical characteristics and influencing factors of recurrent retinal detachment(RD)after surgery for rhegmatogenous retinal detachment(RRD).Methods This was a retrospective case series study.From Jan.2017 to Dec.2021,73 eyes of 73 patients with recurrent RD after surgery in RRD patients were admitted to Shanxi Eye Hospital.All patients were treated with scleral buckling or pars plana vitrectomy.Intraocular tamponades were selected according to the situation.The postoperative follow-up time was at least 3 months after the last surgery,and the postoperative retinal reduction,hole closure,best corrected visual acuity(BCVA)and intraocular pressure were examined.Baseline data and clinical features at relapse were compared,and factors affecting postoperative retinal reduction and visual recovery were evaluated.Results There were 62 cases who underwent one operation after recurrence RD,among which 7 cases of secondary retinal detachment recurred due to unclosed holes;and 11 cases were operated twice after recurrence,among which 2 cases of retinal detachment eventually recurred due to unclosed holes.Postoperative BCVA of the patients was 1.20±0.47,which was significantly improved compared to the 1.57±0.53 before surgery,and the difference was statistically significant(P<0.001).Regression analysis showed that proliferative vitreoretinopathy(PVR)≥grade C(OR=0.10,95%CI:0.01-0.95,P=0.045)and inferior retinal detachment(OR=6.00,95%CI:1.02-35.31,P=0.048)were vital factors causing recurrent RD after RRD.Macular hole in recurrent RD(OR=0.02,95%CI:0.01-0.02,P=0.016)was the main factor affecting postoperative visual acuity recovery.There was a weak positive correlation between RD recurrence duration and final BCVA(r=0.31,P=0.008).Conclusion Patients with recurrent RD still have the risk of recurrence after surgical treatment.PVR grade≥C and inferior retinal detachment are closely related to the incidence of recurrent RD after surgery.