目的 探讨复杂视网膜脱离眼硅油取出手术后视网膜再脱离(RRD)的影响因素及发生原因.方法 回顾性研究.选择行玻璃体切割联合硅油填充手术的连续患者455例458只眼纳入研究.对所有患者行玻璃体切割手术,手术中根据眼内情况酌情行重水、剥膜、视网膜切开或部分切割、眼内激光光凝或冷冻、气液交换或直接油液交换等操作.对伴多发裂孔、陈旧性视网膜脱离、增生及牵拉病变较严重者行环扎手术98只眼.手术完毕时玻璃体腔内填充硅油.硅油取出手术中眼底检查发现有需处理的视网膜前膜者,行切断、剥膜或切除及360°预防性激光光凝治疗等操作,手术中发现裂孔或可疑裂孔者行眼内激光光凝或冷冻治疗.硅油取出手术后1周内及随诊期间均采用与手术前相同的设备和方法行视力、眼压、裂隙灯显微镜、检眼镜等检查.依据硅油取出手术后有无RRD将患眼分为复位组、再脱离组,分别为419、39只眼.对患者年龄、眼轴长度、玻璃体切割手术前最小分辨角对数(LogMAR)最佳矫正视力(BCVA)和眼压、硅油取出手术前LogMAR BCVA和眼压、视网膜裂孔数目、硅油填充时间、随访时间、硅油取出手术后眼压和视力以及玻璃体切割手术和硅油取出手术中相关因素进行记录.统计年龄、性别、高度近视、巨大裂孔、下方裂孔、黄斑裂孔、无晶状体眼、增生性玻璃体视网膜病变(PVR) C3级及以上、既往视网膜脱离手术失败史、360°预防性激光光凝、联合环扎、角膜穿刺取硅油与硅油取出手术后发生RRD的关系.计算年龄＜40岁、性别等因素的比值比(OR)及其95％可信区间(CI).将高度近视眼、联合巩膜环扎及经角膜穿刺硅油取出纳入多元回归方程.结果 硅油取出手术后患眼平均LogMAR BCVA为0.86±0.63,复位组、再脱离组平均LogMAR BCVA分别为0.82±0.59、0.99±0.70,两组平均LogMAR BCVA比较,差异无统计学意义(F=1.559,P＞0.05).复位组和再脱离组高度近视眼分别为116、22只眼,分别占为27.7％、56.4％,差异有统计学意义(x2=13.984,P＜0.01).玻璃体切割手术中联合环扎手术患者中发生RRD 3只眼,占3.1％,未行环扎手术患者发生RRD 36只眼,占10.0％,两者RRD发生率比较,差异有统计学意义(x2 =4.761,P＜0.05).手术后RRD的发生率与手术前PVR程度、既往视网膜脱离手术失败史、无晶状体眼以及预防性视网膜激光光凝等因素均无关性(1.626、1.699、1.986、0.709,95％CI:0.836～3.162、0.832～3.658、0.921～4.279、0.268～1.875,P＞0.05).与高度近视、联合环扎有相关性(OR=3.380、0.284,95％CI:1.733～6.595、0.086～0.944,P＜0.05).通过角膜穿刺取硅油的风险无统计学意义(OR=2.119,95％CI:1.043～4.306,P＞0.05).硅油取出手术后RRD的发生率为8.5％,其中35.9％源于新裂孔的形成,5.1％源于PVR,69.2％与新裂孔相关,51.3％与PVR相关.结论 高度近视眼是硅油取出手术后发生RRD的独立危险因素；联合巩膜环扎手术是硅油取出手术后发生RRD的保护性因素.对于行玻璃体切割及硅油填充手术后视网膜稳定复位眼而言,硅油取出手术后发生RRD的主要原因是新裂孔的形成.PVR可能是RRD后的继发改变.
目的 探討複雜視網膜脫離眼硅油取齣手術後視網膜再脫離(RRD)的影響因素及髮生原因.方法 迴顧性研究.選擇行玻璃體切割聯閤硅油填充手術的連續患者455例458隻眼納入研究.對所有患者行玻璃體切割手術,手術中根據眼內情況酌情行重水、剝膜、視網膜切開或部分切割、眼內激光光凝或冷凍、氣液交換或直接油液交換等操作.對伴多髮裂孔、陳舊性視網膜脫離、增生及牽拉病變較嚴重者行環扎手術98隻眼.手術完畢時玻璃體腔內填充硅油.硅油取齣手術中眼底檢查髮現有需處理的視網膜前膜者,行切斷、剝膜或切除及360°預防性激光光凝治療等操作,手術中髮現裂孔或可疑裂孔者行眼內激光光凝或冷凍治療.硅油取齣手術後1週內及隨診期間均採用與手術前相同的設備和方法行視力、眼壓、裂隙燈顯微鏡、檢眼鏡等檢查.依據硅油取齣手術後有無RRD將患眼分為複位組、再脫離組,分彆為419、39隻眼.對患者年齡、眼軸長度、玻璃體切割手術前最小分辨角對數(LogMAR)最佳矯正視力(BCVA)和眼壓、硅油取齣手術前LogMAR BCVA和眼壓、視網膜裂孔數目、硅油填充時間、隨訪時間、硅油取齣手術後眼壓和視力以及玻璃體切割手術和硅油取齣手術中相關因素進行記錄.統計年齡、性彆、高度近視、巨大裂孔、下方裂孔、黃斑裂孔、無晶狀體眼、增生性玻璃體視網膜病變(PVR) C3級及以上、既往視網膜脫離手術失敗史、360°預防性激光光凝、聯閤環扎、角膜穿刺取硅油與硅油取齣手術後髮生RRD的關繫.計算年齡＜40歲、性彆等因素的比值比(OR)及其95％可信區間(CI).將高度近視眼、聯閤鞏膜環扎及經角膜穿刺硅油取齣納入多元迴歸方程.結果 硅油取齣手術後患眼平均LogMAR BCVA為0.86±0.63,複位組、再脫離組平均LogMAR BCVA分彆為0.82±0.59、0.99±0.70,兩組平均LogMAR BCVA比較,差異無統計學意義(F=1.559,P＞0.05).複位組和再脫離組高度近視眼分彆為116、22隻眼,分彆佔為27.7％、56.4％,差異有統計學意義(x2=13.984,P＜0.01).玻璃體切割手術中聯閤環扎手術患者中髮生RRD 3隻眼,佔3.1％,未行環扎手術患者髮生RRD 36隻眼,佔10.0％,兩者RRD髮生率比較,差異有統計學意義(x2 =4.761,P＜0.05).手術後RRD的髮生率與手術前PVR程度、既往視網膜脫離手術失敗史、無晶狀體眼以及預防性視網膜激光光凝等因素均無關性(1.626、1.699、1.986、0.709,95％CI:0.836～3.162、0.832～3.658、0.921～4.279、0.268～1.875,P＞0.05).與高度近視、聯閤環扎有相關性(OR=3.380、0.284,95％CI:1.733～6.595、0.086～0.944,P＜0.05).通過角膜穿刺取硅油的風險無統計學意義(OR=2.119,95％CI:1.043～4.306,P＞0.05).硅油取齣手術後RRD的髮生率為8.5％,其中35.9％源于新裂孔的形成,5.1％源于PVR,69.2％與新裂孔相關,51.3％與PVR相關.結論 高度近視眼是硅油取齣手術後髮生RRD的獨立危險因素；聯閤鞏膜環扎手術是硅油取齣手術後髮生RRD的保護性因素.對于行玻璃體切割及硅油填充手術後視網膜穩定複位眼而言,硅油取齣手術後髮生RRD的主要原因是新裂孔的形成.PVR可能是RRD後的繼髮改變.
목적 탐토복잡시망막탈리안규유취출수술후시망막재탈리(RRD)적영향인소급발생원인.방법 회고성연구.선택행파리체절할연합규유전충수술적련속환자455례458지안납입연구.대소유환자행파리체절할수술,수술중근거안내정황작정행중수、박막、시망막절개혹부분절할、안내격광광응혹냉동、기액교환혹직접유액교환등조작.대반다발렬공、진구성시망막탈리、증생급견랍병변교엄중자행배찰수술98지안.수술완필시파리체강내전충규유.규유취출수술중안저검사발현유수처리적시망막전막자,행절단、박막혹절제급360°예방성격광광응치료등조작,수술중발현렬공혹가의렬공자행안내격광광응혹냉동치료.규유취출수술후1주내급수진기간균채용여수술전상동적설비화방법행시력、안압、렬극등현미경、검안경등검사.의거규유취출수술후유무RRD장환안분위복위조、재탈리조,분별위419、39지안.대환자년령、안축장도、파리체절할수술전최소분변각대수(LogMAR)최가교정시력(BCVA)화안압、규유취출수술전LogMAR BCVA화안압、시망막렬공수목、규유전충시간、수방시간、규유취출수술후안압화시력이급파리체절할수술화규유취출수술중상관인소진행기록.통계년령、성별、고도근시、거대렬공、하방렬공、황반렬공、무정상체안、증생성파리체시망막병변(PVR) C3급급이상、기왕시망막탈리수술실패사、360°예방성격광광응、연합배찰、각막천자취규유여규유취출수술후발생RRD적관계.계산년령＜40세、성별등인소적비치비(OR)급기95％가신구간(CI).장고도근시안、연합공막배찰급경각막천자규유취출납입다원회귀방정.결과 규유취출수술후환안평균LogMAR BCVA위0.86±0.63,복위조、재탈리조평균LogMAR BCVA분별위0.82±0.59、0.99±0.70,량조평균LogMAR BCVA비교,차이무통계학의의(F=1.559,P＞0.05).복위조화재탈리조고도근시안분별위116、22지안,분별점위27.7％、56.4％,차이유통계학의의(x2=13.984,P＜0.01).파리체절할수술중연합배찰수술환자중발생RRD 3지안,점3.1％,미행배찰수술환자발생RRD 36지안,점10.0％,량자RRD발생솔비교,차이유통계학의의(x2 =4.761,P＜0.05).수술후RRD적발생솔여수술전PVR정도、기왕시망막탈리수술실패사、무정상체안이급예방성시망막격광광응등인소균무관성(1.626、1.699、1.986、0.709,95％CI:0.836～3.162、0.832～3.658、0.921～4.279、0.268～1.875,P＞0.05).여고도근시、연합배찰유상관성(OR=3.380、0.284,95％CI:1.733～6.595、0.086～0.944,P＜0.05).통과각막천자취규유적풍험무통계학의의(OR=2.119,95％CI:1.043～4.306,P＞0.05).규유취출수술후RRD적발생솔위8.5％,기중35.9％원우신렬공적형성,5.1％원우PVR,69.2％여신렬공상관,51.3％여PVR상관.결론 고도근시안시규유취출수술후발생RRD적독립위험인소；연합공막배찰수술시규유취출수술후발생RRD적보호성인소.대우행파리체절할급규유전충수술후시망막은정복위안이언,규유취출수술후발생RRD적주요원인시신렬공적형성.PVR가능시RRD후적계발개변.
Objective To investigate the main causes and risk factors of recurrent retinal detachment (RRD) after silicone oil removal (SOR) in eyes with complex retinal detachment.Methods It was a retrospective case series study.A total of 458 eyes of 455 consecutive patients who underwent pars plana vitrectomy with silicone oil tamponade were recruited in this study.All patients underwent vitrectomy operation.Additionally,they were given heavy water,membrane peeling,retinotomy or partial cutting,intraocular laser photocoagulation or frozen,gas-liquid exchange or direct oil exchange operation accordingly.Ninety-eight eyes with multiple holes,old retinal detachment,hyperplasia and serious traction lesions underwent scleral buckling surgery simultaneously.Intravitreal silicone oil was padded at the end of operation.Cutting,stripping or resection and 360° preventive laser photocoagulation were applied while the epiretinal membrane was found and need treatment during SOR.Holes or suspicious hiatus underwent intraocular laser photocoagulation or cryotherapy during the operation.One week after SOR and during follow-up,the visual acuity,intraocular pressure (IOP),slit lamp microscope,and ophthalmoscope examination were examined with the same technique and methods as preoperation.The eyes were divide into two groups based on the attachment status of retina after SOR,which were reattached group (419 eyes) and redetached group (39 eyes) respectively.The following data were recorded.,the age of patients,ocular axial length,logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) and IOP before vitrectomy operation and before and after SOR,the number of retinal breaks,the duration of silicone oil filling,the duration of follow-up,and the related factors during vitrectomy operation and SOR.The relation of age,sex,high myopia,the size and location of holes,aphakic eye,proliferative vitreoretinopathy (PVR) C3 level and above,previous history of failed retinal detachment operation,360° preventive laser photocoagulation,assistant scleral buckling surgery,SOR via corneal puncture to RRD after SOR were analyzed.Odds ratio (OR) and its 95％ confidence interval (CI) were calculated for the age ＜40 years old and gender.High myopia,assistant scleral buckling surgery and SOR via corneal puncture were further analyzed by multiple regression equation.Results After SOR operation,the total average logMAR BCVA was 0.86 ± 0.63.The average logMAR BCVA was 0.82 ± 0.59 and 0.99 ± 0.70 respectively for the reattached and redetached groups,which was not statistically different (F=1.559,P＞0.05).The number of high myopia eyes in the reattached and redetached groups were 116 and 22 eyes,respectively,accounted for 27.7 ％ and 56.4 ％,and the difference was statistically significant (x2=13.984,P＜0.01).Three eyes underwent vitrectomy with scleral buckling occured RRD,accounting for 3.1％; while 36 eyes underwent vitrectomy without scleral buckling occured RRD,accounting for 10.0％.The incidence of RRD between them was statistically significant (x2 =4.761,P＜0.05).The incidence of RRD was not retated to the PVR levels before the operation,previous history of failed retinal detachment operation,aphakic eye and preventive laser photocoagulation (OR=1.626,1.699,1.986,0.709; 95％ CI:0.836-3.162,0.832-3.658,0.921-4.279,0.268-1.875; P＞0.05).RRD had a close relation with high myopia and assistant scleral buckling surgery (OR=3.380,0.284; 95％CI:1.733-6.595,0.086-0.944; P＜0.05).The raise of risk derived from SOR via corneal puncture had no statistical significance (OR=2.119; 95％CI:1.043-4.306; P＞0.05).The incidence of RRD after SOR was 8.5％; of which,35.9％ originated from new breaks and 69.2％ were related to new breaks,in contrast,only 5.1％ originated from PVR but 51.3％ were related to PVR.Conclusions High myopia is an independent prognostic risk factor of RRD after SOR.Combined scleral buckling surgery is a protective factor of RRD after SOR.To the well reattached eyes before SOR,the new breaks seems to be the main cause of RRD,wheras PVR was probably a secondary phenomenon.
