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白内障术后视网膜脱落的相关因素及不同术式治疗后视力恢复效果观察

Related Factors of Retinal Detachment after Cataract Surgery and the Visual Recovery Effects after Different Surgical Methods
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摘要 目的:分析白内障术后视网膜脱落(RD)的相关因素及不同术式治疗后视力恢复效果。方法:选取2013年7月~2017年7月期间在我院接受白内障手术治疗后发生RD的85例(85只眼)患者、未发生RD的120例(120只眼)患者,分别为RD组、对照组。收集两组患者的临床资料。RD组患者根据RD范围、裂孔大小、数目及患者意愿等选择不同术式治疗,术后评估不同手术治疗效果。结果:RD组患者中男性、老年、中高度近视、既往接受Nd:YAG激光术、术中晶体后囊破裂者占比显著高于对照组。Logistic多因素分析显示男性、中高度近视、既往接受Nd:YAG激光术、术中晶体后囊破裂是白内障术后RD发生的危险因素。玻璃体切除手术(PPV)术、巩膜冷凝术、激光光凝术术后视网膜一次复位率分别为100%、93.75%、90.91%,差异无统计学意义。PPV术后最佳矫正视力明显较巩膜冷凝术、激光光凝术高,其中PPV术联合惰性气体填充术或硅油填充术术后视力恢复效果更好。结论:男性、中高度近视、既往接受Nd:YAG激光术、术中晶体后囊破裂的患者白内障术后更易发生RD,建议术前、术中采取针对性措施防止RD,一旦发生RD,可优先考虑PPV术联合惰性气体填充术或硅油填充术治疗。 Objective To analyze the related factors of retinal detachment(RD)after cataract surgery and the visual recovery effects after different surgical methods.Methods 85 cases(85 eyes)of patients with RD and 120 cases(120 eyes)of patients without RD after cataract surgery in our hospital from July 2013 to July 2017 were enrolled and were divided into the RD group and the control group respectively.The clinical data of the two groups were collected.The RD group was given the different surgical methods according to the RD range,split size,number,and wishes of patients,and the treatment effects of different surgical methods were evaluated after operation.Results The proportions of male,elderly,middle and high myopia,Nd:YAG laser surgery history,and intraoperative posterior capsular rupture were significantly higher in the RD group than those in the control group.Logistic multivariate analysis showed that male,middle and high myopia,Nd:YAG laser surgery history,and intraoperative posterior capsular rupture were the risk factors for RD after cataract surgery.The postoperative primary retinal reattachment rates were 100%,93.75%and 90.91%respectively in pasplana vitrectomy(PPV),scleral cryocoagulation and laser photocoagulation.The best corrected visual acuity after PPV was significantly higher than that by scleral cryocoagulation and laser photocoagulation,and the better postoperative visual recovery would be shown by PPV combined with inert gas filling or silicone oil filling.Conclusions Patients with the features of male,middle and high myopia,the Nd:YAG laser surgery history and intraoperative posterior capsular rupture are more prone to RD after cataract surgery,therefore the preoperative,intraoperative targeted measures are recommended to prevent RD,and the PPV surgery combined with inert gas filling or silicone oil filling can be given priority to surgery once the RD occurs.
作者 胡开东 Hu Kai-dong(Ophthalmology Department of Guangyuan Third People’s Hospital,Guangyuan 628001,China)
出处 《湖南师范大学学报:医学版》 2020年第1期116-119,共4页 Journal of Hunan Normal University(Medical Sciences)
关键词 白内障 视网膜脱落 因素 术式 视力恢复 cataract retinal detachment factors surgical methods visual recovery
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