孔源性视网膜脱离手术后视网膜再脱离原因分析

Reason of Redetachmeny in Rhegmatogenous Retinal Detachment

目的 :分析孔源性视网膜脱离手术后视网膜再脱离的原因。方法 :回顾性分析 96例孔源性视网膜脱离 96只眼视网膜复位手术后视网膜再脱离时裂孔大小、数量、位置以及与手术方法、增殖性玻璃体视网膜病变(proliferativevitreoretinopathy,PVR)、再脱离持续时间、屈光状态的关系。用卡方检验对比分析 2次手术前裂孔大小构成比和裂孔部位 ;配对秩和检验分析PVR分级 ;Spearman等级相关检验分析裂孔大小、数量及再脱离持续时间与PVR的关系。结果 :视网膜再脱离与第一次手术前裂孔大小构成比的差别具有显著性意义 (X2 =1 4 1 0 4 ,P<0 0 0 5 ) ,视网膜再脱离时 <1PD裂孔比例增多 ,而 1～ 3PD裂孔比例减少 (X2 =1 3 6 72 ,P <0 0 0 1 ,X2 =1 0 6 30 ,P <0 0 0 1 )。第 2次手术前PVR级别较第 1次加重 (T =6 7885 ,P <0 0 0 1 )。第 2次手术前裂孔大小、数量、位置与PVR无相关性 (rsA=0 0 6 9,PA=0 6 0 5 ,rsB=0 1 37,PB=0 30 2 ,A :大小 ,B :数量 )。PVR级别与再脱离持续时间呈正相关 (rs=0 4 4 6 ,P =0 0 0 0 )。结论 :孔源性视网膜脱离手术后视网膜再脱离的原因有新裂孔形成、原裂孔未封闭、遗漏裂孔、PVR形成或发展。

Objective:To investigate the reasons of redetachment in rhegmatogenous retinal detachment and possible factors of proliferative vitreoretinopathy(PVR).Methods:We retrospectively analysised the size,number and position of retinal breaks,surgical methods,the continuous time of redetachment in 96 cases(96 eyes).Results:The ratio of break size had significant difference between primary and second surgery(chi-squre test X 2=14 104, P <0 005).The ratio of breaks less 1PD was increased compared with primary surgery,while breaks of 1-3PD reduced by mutiple comparison(X 2=13 672, P <0 001,X 2=10 630, P <0 001).Statistics showed that PVR in second operation was significantly severe than that in primary surgery(paired rank sun test T=6 7885, P <0 001).No significant difference was identified between PVR and size?number and position of breaks in analysis of Spearman rank correlation(rs A=0 069, P A=0 605,rs B=0 137, P B=0 302),whereas PVR and the continuous time of redetachment had significant difference before second surgery(rs=0 446, P =0 000).Conclusion:The reasons of rhegmatogenous retinal detachment are new breaks formation,primary breaks reopening,breaks omission,PVR formation or development and inadequate surgery.