中华眼底病杂志
中華眼底病雜誌
중화안저병잡지
CHINESE JOURNAL OF OCULAR FUNDUS DISEASES
2014年
4期
352-356
,共5页
视网膜脱离/外科学%体层摄影术,光学相干%视网膜下液%巩膜扣带术
視網膜脫離/外科學%體層攝影術,光學相榦%視網膜下液%鞏膜釦帶術
시망막탈리/외과학%체층섭영술,광학상간%시망막하액%공막구대술
Retinal detachment/surgery%Tomography,optical coherence%Subretinal fluid%Scleral buckling
目的 观察巩膜扣带手术后持续性黄斑下积液(SMF)的发生及转归,探讨SMF发生的相关因素及其对视力的影响.方法 行巩膜扣带手术且符合纳入标准的连续病例89例90只眼纳入研究.患者均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、三面镜、间接检眼镜、B型超声检查.90只眼中,伴萎缩性裂孔者21只眼,伴马蹄形裂孔者42只眼;陈旧性视网膜脱离者22只眼,非陈旧性视网膜脱离者68只眼.行巩膜环扎手术(SE组)32只眼,行巩膜外垫压手术(SSB组)58只眼.手术后1个月行光相干断层扫描(OCT)检查,根据有无SMF将患眼分为SMF组、NSMF组.手术后1、3、6、12个月及末次随访时,除常规眼科检查外,均行OCT检查.手术后随访时间1年及以上,且SMF完全消失6个月以上.结果 OCT检查,手术后1个月,SE组、SSB组患眼中存在SMF为20、23只眼,分别占各组患眼的62.5％、39.7％.两组SMF发生率比较,差异有统计学意义(x2=5.024,P＜0.05).伴萎缩性裂孔 21只眼中,发生SMF 14只眼,占66.7％;伴马蹄形裂孔 42只眼中,发生SMF 16只眼,占38.1％.两者SMF发生率比较,差异有统计学意义(x2 =4.582,P＜0.05).陈旧性视网膜脱离者22只眼中,发生SMF 16只眼,占72.7％;非陈旧性者68只眼中,发生SMF 27只眼,占39.7％,两者SMF发生率比较,差异有统计学意义(x2=7.264,P＜0.01).手术后各随访时间点,SE组、SSB组患眼平均logMAR BCVA比较,差异均无统计学意义(t=0.659、0.699、1.108、1.037、1.902,P＞0.05).手术后1、3个月,NSMF组、SMF组平均logMAR BCVA比较,差异无统计学意义(t=1.812、1.957,P＞0.05);6、12个月和末次随访时,两组平均logMAR BCVA比较,差异均有统计学意义(t=2.324、2.147、2.184,P＜0.05).结论 巩膜环扎手术后SMF发生率较外垫压手术后高;裂孔类型和陈旧性视网膜脱离是可能的潜在影响因素;SMF持续不能吸收可能影响手术后最终视力.
目的 觀察鞏膜釦帶手術後持續性黃斑下積液(SMF)的髮生及轉歸,探討SMF髮生的相關因素及其對視力的影響.方法 行鞏膜釦帶手術且符閤納入標準的連續病例89例90隻眼納入研究.患者均行最佳矯正視力(BCVA)、眼壓、裂隙燈顯微鏡、三麵鏡、間接檢眼鏡、B型超聲檢查.90隻眼中,伴萎縮性裂孔者21隻眼,伴馬蹄形裂孔者42隻眼;陳舊性視網膜脫離者22隻眼,非陳舊性視網膜脫離者68隻眼.行鞏膜環扎手術(SE組)32隻眼,行鞏膜外墊壓手術(SSB組)58隻眼.手術後1箇月行光相榦斷層掃描(OCT)檢查,根據有無SMF將患眼分為SMF組、NSMF組.手術後1、3、6、12箇月及末次隨訪時,除常規眼科檢查外,均行OCT檢查.手術後隨訪時間1年及以上,且SMF完全消失6箇月以上.結果 OCT檢查,手術後1箇月,SE組、SSB組患眼中存在SMF為20、23隻眼,分彆佔各組患眼的62.5％、39.7％.兩組SMF髮生率比較,差異有統計學意義(x2=5.024,P＜0.05).伴萎縮性裂孔 21隻眼中,髮生SMF 14隻眼,佔66.7％;伴馬蹄形裂孔 42隻眼中,髮生SMF 16隻眼,佔38.1％.兩者SMF髮生率比較,差異有統計學意義(x2 =4.582,P＜0.05).陳舊性視網膜脫離者22隻眼中,髮生SMF 16隻眼,佔72.7％;非陳舊性者68隻眼中,髮生SMF 27隻眼,佔39.7％,兩者SMF髮生率比較,差異有統計學意義(x2=7.264,P＜0.01).手術後各隨訪時間點,SE組、SSB組患眼平均logMAR BCVA比較,差異均無統計學意義(t=0.659、0.699、1.108、1.037、1.902,P＞0.05).手術後1、3箇月,NSMF組、SMF組平均logMAR BCVA比較,差異無統計學意義(t=1.812、1.957,P＞0.05);6、12箇月和末次隨訪時,兩組平均logMAR BCVA比較,差異均有統計學意義(t=2.324、2.147、2.184,P＜0.05).結論 鞏膜環扎手術後SMF髮生率較外墊壓手術後高;裂孔類型和陳舊性視網膜脫離是可能的潛在影響因素;SMF持續不能吸收可能影響手術後最終視力.
목적 관찰공막구대수술후지속성황반하적액(SMF)적발생급전귀,탐토SMF발생적상관인소급기대시력적영향.방법 행공막구대수술차부합납입표준적련속병례89례90지안납입연구.환자균행최가교정시력(BCVA)、안압、렬극등현미경、삼면경、간접검안경、B형초성검사.90지안중,반위축성렬공자21지안,반마제형렬공자42지안;진구성시망막탈리자22지안,비진구성시망막탈리자68지안.행공막배찰수술(SE조)32지안,행공막외점압수술(SSB조)58지안.수술후1개월행광상간단층소묘(OCT)검사,근거유무SMF장환안분위SMF조、NSMF조.수술후1、3、6、12개월급말차수방시,제상규안과검사외,균행OCT검사.수술후수방시간1년급이상,차SMF완전소실6개월이상.결과 OCT검사,수술후1개월,SE조、SSB조환안중존재SMF위20、23지안,분별점각조환안적62.5％、39.7％.량조SMF발생솔비교,차이유통계학의의(x2=5.024,P＜0.05).반위축성렬공 21지안중,발생SMF 14지안,점66.7％;반마제형렬공 42지안중,발생SMF 16지안,점38.1％.량자SMF발생솔비교,차이유통계학의의(x2 =4.582,P＜0.05).진구성시망막탈리자22지안중,발생SMF 16지안,점72.7％;비진구성자68지안중,발생SMF 27지안,점39.7％,량자SMF발생솔비교,차이유통계학의의(x2=7.264,P＜0.01).수술후각수방시간점,SE조、SSB조환안평균logMAR BCVA비교,차이균무통계학의의(t=0.659、0.699、1.108、1.037、1.902,P＞0.05).수술후1、3개월,NSMF조、SMF조평균logMAR BCVA비교,차이무통계학의의(t=1.812、1.957,P＞0.05);6、12개월화말차수방시,량조평균logMAR BCVA비교,차이균유통계학의의(t=2.324、2.147、2.184,P＜0.05).결론 공막배찰수술후SMF발생솔교외점압수술후고;렬공류형화진구성시망막탈리시가능적잠재영향인소;SMF지속불능흡수가능영향수술후최종시력.
Objective To observe the occurrence and evolution of persistent submacular fluid (SMF) after scleral buckling surgery (SB) in rhegmatogenous retinal detachment,and then to study the related factors of persistent SMF and the effect of persistent SMF on visual outcome.Methods Ninety eyes of 89 patients with rhegmatogenous retinal detachment which had been performed SB were included in this study.Best corrected visual acuity (BCVA),intraocular pressure,slit-lamp microscopy,three mirror contact lens,indirect ophthalmoscopy and B-scan ultrasonography were measured for all patients.There were 21 eyes with atrophic holes while 42 eyes with horse-shoe tears,22 eyes with old retinal detachment while 68 new suffered eyes.Thirty-two eyes underwent scleral encircling surgery (SE) and 58 eyes underwent segmental scleral buckling surgery (SSB).The patients were divided into SMF group and non-SMF (NSMF) group according to the results of optical coherence tomography (OCT) at 1 month postoperatively.Thorough ophthalmologic examinations were performd at 1,3,6 and 12 months after surgery to the patients,further observations were continued to carry out unless the abnormality had resolved for at least 6 months.Results Patients who underwent SE (20 eyes,62.5 ％) had a higher incidence of persistent SMF at 1 month after surgery than those who underwent SSB (23 eyes,39.7 ％),the difference was significant (x2 =5.024,P＜ 0.05).Persistent SMF was more frequent in eyes with atrophic holes (66.7％) than that with horseshoe tears (38.1％),the difference was significant (x2 =4.582,P＜0.05).Persistent SMF was found in 72.7％ old retinal detachment eyes and in 39.7％ new suffered eyes,showed a striking differences (x2=7.264,P＜0.01).There was no significant difference in BCVA among SE and SSB groups at every time point (t=0.659,0.699,1.108,1.037,1.902; P＞0.05).The SMF group have a similar BCVA with NSMF group 1 and 3 months after surgery (t=1.812,1.957; P＞0.05),whereas the SMF group showed worse BCVA than NSMF group from since 6 months after surgery (t=2.324,2.147,2.184; P＜0.05).Conclusions Persistent SMF is more frequent after SE than SSB,the type of retinal breaks and old retinal detachment may be the potential influencing factors.Persistent SMF after SB may affect the final visual outcome.
