CAJ | 학술논문

目的：分析白内障施行超声乳化联合人工晶状体植入术后视网膜脱离的相关因素。方法回顾性分析在首都医科大学宣武医院眼科及北京大学第三医院眼科中心白内障患者接受超声乳化联合人工晶状体植入术,术后发生视网膜脱离临床资料。对晶状体后囊情况,视网膜脱离,手术治疗方法,患者性别、屈光状态及年龄等情况进行统计学分析。结果80例(80只眼),男49人,女31人。43例(43只眼)晶状体后囊破裂,男31人(72.09%),32只眼(74.42%)出现孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD),11只眼高度近视合并RRD；7只眼(16.28%)同时发生了脉络膜脱离；22只眼(51.16%)施行玻璃体切除术( pars plana vitrectomy,PPV)联合惰性气体填充术,17只眼(39.53%)施行PPV联合硅油填充术,4只眼行巩膜外加压术(sclera buckling, SB)。37例(37只眼)晶状体后囊完整,男18人(48.65%),25只眼(67.57%)出现RRD,12只眼高度近视合并RRD；无一例发生脉络膜脱离；19只眼(51.35%)施行PPV联合惰性气体填充术,7只眼(18.92%)行PPV联合硅油填充术,11只眼行SB。后囊破裂者RRD合并脉络膜脱离的比例显著高于后囊完整者(χ2=4.719,P=0.03)。后囊破裂者行PPV的比例显著高于后囊完整者(χ2=5.447,P=0.02)。后囊破裂者行PPV+硅油的比例显著高于后囊完整者(χ2=4.025,P=0.045)。后囊破裂组的男性比例显著高于后囊完整组(χ2=4.606,P=0.032)。结论后囊破裂使视网膜脱离情况更加严重,甚至合并脉膜脱离,常需采用PPV甚至PPV+硅油填充治疗。男性更易发生后囊破裂,导致RRD。
목적：분석백내장시행초성유화연합인공정상체식입술후시망막탈리적상관인소。방법회고성분석재수도의과대학선무의원안과급북경대학제삼의원안과중심백내장환자접수초성유화연합인공정상체식입술,술후발생시망막탈리림상자료。대정상체후낭정황,시망막탈리,수술치료방법,환자성별、굴광상태급년령등정황진행통계학분석。결과80례(80지안),남49인,녀31인。43례(43지안)정상체후낭파렬,남31인(72.09%),32지안(74.42%)출현공원성시망막탈리(rhegmatogenous retinal detachment,RRD),11지안고도근시합병RRD；7지안(16.28%)동시발생료맥락막탈리；22지안(51.16%)시행파리체절제술( pars plana vitrectomy,PPV)연합타성기체전충술,17지안(39.53%)시행PPV연합규유전충술,4지안행공막외가압술(sclera buckling, SB)。37례(37지안)정상체후낭완정,남18인(48.65%),25지안(67.57%)출현RRD,12지안고도근시합병RRD；무일례발생맥락막탈리；19지안(51.35%)시행PPV연합타성기체전충술,7지안(18.92%)행PPV연합규유전충술,11지안행SB。후낭파렬자RRD합병맥락막탈리적비례현저고우후낭완정자(χ2=4.719,P=0.03)。후낭파렬자행PPV적비례현저고우후낭완정자(χ2=5.447,P=0.02)。후낭파렬자행PPV+규유적비례현저고우후낭완정자(χ2=4.025,P=0.045)。후낭파렬조적남성비례현저고우후낭완정조(χ2=4.606,P=0.032)。결론후낭파렬사시망막탈리정황경가엄중,심지합병맥막탈리,상수채용PPV심지PPV+규유전충치료。남성경역발생후낭파렬,도치RRD。
Objective To analyze the correlative factors of rhegmatogenous retinal detachment ( RRD) after phacoemulsification with intraocular lens implantation. Methods The clinical data of patients with RRD after phacoemulsification with intraocular lens implantation in Xuanwu Hospital and Eye Center of Peking University were retrospectively analyzed. The posterior capsule, retinal detachment, surgery, gender, refraction status and age were statistically analyzed. Results Eighty eyes of 80 cases included 49 male cases and 31 female cases. Posterior capsule rupture occurred in 43 eyes including 37 cases (72. 09%) of male which was caused by rhegmatogenous retinal detachment ( RRD) in 32 eyes and high myopia and RRD in 11 eyes. The choroidal detachment occurred in 7 eyes. Pars plana vitrectomy ( PPV) combined with gas tamponade was performed in 22 eyes. PPV combined with silicone oil tamponade was performed in 17 eyes. Sclera buckling ( SB) was performed in 4 eyes. Posterior capsule rupture occurred in 37 eyes including with 18 cases (48. 65%) of male during which RRD was 25 eyes and high myopia and RRD was 12 eyes. No choroidal detachment happened. PPV combined with gas tamponade was performed in 19 eyes. PPV combined with silicone oil tamponade was performed in 7 eyes, and SB was performed in 11 eyes. The proportion of the RRD combined with choroidal detachment in the posterior capsule rupture eyes was obviously higher than that in the intact posterior capsule eyes. The proportion of PPV in the posterior capsule rupture eyes was obviously higher than that in the intact posterior capsule eye (χ2 =5. 447,P=0. 02). The proportion of PPV with silicone oil in the posterior capsule rupture eyes was obviously higher than that in the intact posterior capsule eyes(χ2 =4. 025,P=0. 045). The proportion of male with posterior capsule rupture was obviously higher than that with intact posterior capsule(χ2 =4. 606,P=0. 032). Conclusion Posterior capsular rupture could cause more complex and serious retinal detachment, even combined with choroidal detachment. In these cases, PPV and PPV with silicone oil tamponade are always performed. Male patients are more likely to suffer posterior capsule rupture which leads to RRD.