视网膜脱离巩膜扣带术后严重增生性玻璃体视网膜病变发生的危险因素

Clinical risk factors for severe proliferative vitreoretinopathy after scleral buckling surgery

目的 探讨孔源性视网膜脱离巩膜扣带术后严重增生性玻璃体视网膜病变 ( proliferativevitreoretinopathy,PVR)发生的临床危险因素。 方法 采用病例对照研究方法 ,回顾性分析 40 31例( 40 31只眼 ) PVR低于 C1级、行视网膜脱离巩膜扣带术患者的临床资料。记录患眼眼压值、晶状体和玻璃体状态、视网膜脱离特征、是否伴发脉络膜脱离等 2 2个临床特征。 40 31例患者中 ,有 2 6 6 0例手术后随访时间 3个月以上 ,其中 72例 ( 72只眼 )因为巩膜扣带术后 [12～ 2 10 d ,平均时间 ( 6 0 .3± 41.0 ) d]发生严重PVR导致视网膜再脱离 ,回到我科行第 2次玻璃体切割术 ,纳入 PVR组 ;从剩下的 2 5 88例患者资料中随机调取 72例 ( 72只眼 )视网膜复位 3个月以上患者的临床资料纳入对照组。应用 SPSS( 10 .0 )软件将 2组分析结果进行单元和多元 L ogistic回归分析。 结果 视网膜脱离巩膜扣带术后严重 PVR发生的相关因素为 :巩膜扣带术前呈现不完全性玻璃体后脱离 ( P<0 .0 0 1) ,眼压低于 7mm Hg( 1mm Hg=0 .133k Pa)( P<0 .0 0 2 ) ,以及单一视网膜裂孔大小大于 2个视盘直径 ( disc diameter,DD) ( P<0 .0 0 5 )。 结论 孔源性视网膜脱离患者巩膜扣带术前有不完全性玻璃体后脱离、低眼压及单一视网膜裂孔大小大?

Objective To analyze the clinical risk factors of the occurrence of severe proliferative vitreoretinopathy (PVR) after scleral reattachment surgery. Methods A total of 4 031 eyes of 4 031 consecutive patients with reghmatogenous retinal detachment (RRD) and PVR (grade C1 or less), on whom the scleral buckling was performed, were retrospectively studied. Twenty-two clinical characteristics of the patients (including the ocular tension, condition of lens and vitreous, characteristics of retinal detachment, whether or not with choroidal detachment, et al) were recorded. In 4 031 patients, 2 660 were followed up for more than 3 months, and 72 (in PVR group) of the 2 660 patients underwent the second surgery (vitreoretinal surgery) because of the occurrence of postoperative severe PVR; in the other 2 588patients, 72 (72 eyes) with retinal reattachment for more than 3 months were selected randomly as the control. The data were analyzed in SPSS (10.0) software. Results Logistic regression analysis revealed that the significant risk factors for PVR were incomplete posterior vitreous detachment (P<0.001), intraocular pressure <7 mm Hg( 1 mm Hg =0.133 kPa, P<0.002), and large retinal tear (>2 DD,P<0.005). Conclusion Incomplete posterior vitreous detachment, intraocular pressure <7 mm Hgand large retinal tear of the patient with RRD may be the major risk factors for PVR.