CAJ | 학술논문

目的观察玻璃体切割手术(PPV)治疗Eales病严重并发症的效果.方法回顾性分析接受首次PPV治疗的Eales病患者27例30只眼的临床资料.患者中,男性20例,女性7例;年龄15～54岁,平均年龄30.7岁.最佳矫正视力(BCVA)为眼前手动～0.5.根据检查结果将患者分为玻璃体积血组、玻璃体增生机化组、局部视网膜脱离组和广泛视网膜脱离组,分别为3、14、7、6只眼.手术方式为标准PPV,必要时联合巩膜扣带手术、晶状体切除手术、眼内激光光凝、巩膜外冷冻、电凝、增牛膜剥离切断、视网膜切开或切除、气液交换、玻璃体腔注射曲安奈德、膨胀性气体及硅油填充.30只眼分别接受1～8次手术,平均手术次数2.4次.手术后随访观察6个月～10年.对比观察治疗前后BCVA、视网膜复位以及并发症发生情况.结果末次随访时,BCVA光感～1.5.其中,BCVA≥0.1者24只眼,占80.0%;0.03者1只眼,占3.3%;数指者1只眼,占3.3%;手动者3只眼,占10.0%;光感者1只眼,占3.3%.BCVA提高者22只眼,占73.3%;不变者2只眼,占6.7%;下降者6只眼,占20.0%.手术前后BCVA比较,差异有统计学意义(t=5.132,P＜0.01).广泛视网膜脱离组BCVA较其他3组低,差异均有统计学意义(F=4.570,P均＜0.05);单纯玻璃体积血组视力预后较好,但与玻璃体机化增生组和视网膜局部脱离组比较,差异无统计学意义(P＞0.05).所有患眼PPV手术后第1天视网膜完全复位.末次随访时,无硅油填充视网膜在位24只眼;患者拒绝手术,局部视网膜脱离1只眼;硅油依赖眼5只眼.出现并发症16只眼,占53.3%.结论玻璃体视网膜手术是治疗Eales病严重并发症的有效手段,手术前存在广泛视网膜脱离的患眼手术后视力预后较差.
목적 관찰파리체절할수술(PPV)치료Eales병엄중병발증적효과.방법 회고성분석접수수차PPV치료적Eales병환자27례30지안적림상자료.환자중,남성20례,녀성7례;년령15～54세,평균년령30.7세.최가교정시력(BCVA)위안전수동～0.5.근거검사결과장환자분위파리체적혈조、파리체증생궤화조、국부시망막탈리조화엄범시망막탈리조,분별위3、14、7、6지안.수술방식위표준PPV,필요시연합공막구대수술、정상체절제수술、안내격광광응、공막외냉동、전응、증우막박리절단、시망막절개혹절제、기액교환、파리체강주사곡안내덕、팽창성기체급규유전충.30지안분별접수1～8차수술,평균수술차수2.4차.수술후수방관찰6개월～10년.대비관찰치료전후BCVA、시망막복위이급병발증발생정황.결과 말차수방시,BCVA광감～1.5.기중,BCVA≥0.1자24지안,점80.0%;0.03자1지안,점3.3%;수지자1지안,점3.3%;수동자3지안,점10.0%;광감자1지안,점3.3%.BCVA제고자22지안,점73.3%;불변자2지안,점6.7%;하강자6지안,점20.0%.수술전후BCVA비교,차이유통계학의의(t=5.132,P＜0.01).엄범시망막탈리조BCVA교기타3조저,차이균유통계학의의(F=4.570,P균＜0.05);단순파리체적혈조시력예후교호,단여파리체궤화증생조화시망막국부탈리조비교,차이무통계학의의(P＞0.05).소유환안PPV수술후제1천시망막완전복위.말차수방시,무규유전충시망막재위24지안;환자거절수술,국부시망막탈리1지안;규유의뢰안5지안.출현병발증16지안,점53.3%.결론 파리체시망막수술시치료Eales병엄중병발증적유효수단,수술전존재엄범시망막탈리적환안수술후시력예후교차.
Objective To observe the clinical efficacy of vitrectomy on the serious complications of Eales disease. Methods The clinical data of 30 eyes of 27 patients (20 males and 7 females) with Eales disease who underwent vitrectomy were retrospectively analyzed. The age was ranged from 15 to 54 years old, with a mean of 30.7 years. The best corrected visual acuity (BCVA) was ranged from hand movement to 0.5. The patients were divided into the vitreous hemorrhage group (3 eyes ), proliferative vitreoretinopathy group (14 eyes), local retinal detachment group (7 eyes), and wide retinal detachment group (6 eyes) according to the results of examinations. The standard pars plana vitrectomy (PPV) were performed and scleral buckling, lensectomy, endolaser, transscleral cryotherapy/cautery, membrane removal, retinotomy, fluid-air exchange, intravitreal injection of triamcinolone, gas/oil tamponade can be combined if necessary. Those eyes underwent 1 to 8 times (with a mean of 2.4 times) of surgery. The follow-up was ranged from 6 months to 10 years. The BCVA, retinal reattachment, complications before and after surgery was comparatively analyzed. Results At the end of the follow-up, the BCVA was ranged from light perception to 1.5. The BCVA was ＞0.1 in 24 eyes (80.0%) ,0.03 in 1 eye (3.3%), counting finger in 1 eye (3.3%), hand moving in 3 eyes (10.0%) and light perception in 1 eye (3.3%). The BCVA improved in 22 eyes (73.3%), stable in 2 eyes (6.7%) and decreased in 6 eyes (20.0%). The differences are statistically significant between pre- and postoperative BCVA (t=5.132, P＜0.01). The BCVA of wide retinal detachment group was less than other 3 groups (F=4.570, P＜0.05); while the BCVA of vitreous hemorrhage group, proliferative vitreoretinopathy group and local retinal detachment group was the same (P＞0.05). Complete retinal reattachment was achieved in all eyes at the next day after PPV. At the end of the follow-up, retina reattached in 24 eyes without silicone oil tamponade, local retinal detachment occurred in 1 eye (the patient refused further surgery) and silicone oil tamponade-dependant retinal reattachment 5eyes. During the follow-up, 16 eyes (53.3 %) had developed some complications. Conclusions Vitrectomy is an effective way to cure serious complications of Eales disease. The BACV prognosis of patients with wide retinal detachment is poor.