[1]周永莹,卢谦益.孔源性视网膜脱离患者术后视网膜再次脱离的危险因素分析[J].眼科新进展,2024,44(1):058-61.[doi:10.13389/j.cnki.rao.2024.0011]
　ZHOU Yongying,LU Qianyi.Analysis of risk factors for postoperative retinal re-detachment in patients with rhegmatogenous retinal detachment[J].Recent Advances in Ophthalmology,2024,44(1):058-61.[doi:10.13389/j.cnki.rao.2024.0011]
点击复制

孔源性视网膜脱离患者术后视网膜再次脱离的危险因素分析/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
44卷
期数:
2024年1期
页码:
058-61
栏目:
应用研究
出版日期:
2024-01-05

文章信息/Info

Title:
Analysis of risk factors for postoperative retinal re-detachment in patients with rhegmatogenous retinal detachment
作者:
周永莹; 卢谦益
215200　江苏省苏州市，苏州市吴江区儿童医院眼科（周永莹，卢谦益）；215006　江苏省苏州市，苏州大学附属第一医院眼科（卢谦益）
Author(s):
ZHOU Yongying1; 2; LU Qianyi2
1.Department of Ophthalmology,Children’s Hospital of Wujiang District,Suzhou 215200,Jiangsu Province,China 2.Department of Ophthalmology,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China
关键词:
孔源性视网膜脱离; 眼轴长度; 复发性视网膜脱离
Keywords:
rhegmatogenous retinal detachment;  axial length;  recurrent retinal detachment
分类号:
R774
DOI:
10.13389/j.cnki.rao.2024.0011
文献标志码:
A
摘要:
目的　探讨影响孔源性视网膜脱离（RRD）患者术后视网膜再次脱离的危险因素。方法　选取2020年10月至2022年4月于苏州大学附属第一医院眼科进行检查并确诊为RRD的患者403例403眼作为研究对象，其中行巩膜扣带术35眼，玻璃体切割术（PPV）+玻璃体空气填充79眼，PPV+玻璃体硅油填充222眼，PPV+玻璃体硅油填充+取油术67眼。术后连续随访至少3个月。通过单因素和多因素Logistic 分析影响RRD术后视网膜一次性未复位的危险因素，并应用Logistic回归构建风险预测模型。结果　本组共369眼术后视网膜一次性复位，34眼未复位，一次性复位率为91.6%。单因素分析结果显示，术后视网膜一次性复位和未复位患者眼轴长度（AL）、手术方式、裂孔位置、裂孔大小差异均有统计学意义（均为P＜0.05）。由回归方程可知：AL≥26 mm的患者，RRD术后视网膜一次性未复位发生的风险比AL＜26 mm的患者增加了4.248倍（P＜0.05）。多因素 Logistic回归结果显示，AL、裂孔位置、裂孔大小、手术方式是影响RRD术后视网膜未复位的危险因素（均为P＜0.05）。H-L检验P=0.165，ROC分析结果显示，预测RRD术后视网膜是否发生再次脱离的曲线下面积为0.892，95%CI：0.832~0.953，灵敏度和特异度分别为79.4%和87.3%（P＜0.05）。结论　AL是影响RRD术后视网膜再次脱离的独立危险因素，且由AL、裂孔位置、裂孔大小、手术方式构建的预测模型可较为精准的预测RRD术后视网膜是否发生再次脱离。
Abstract:
Objective　To explore the risk factors that may cause recurrent retinal detachment in rhegmatogenous retinal detachment (RRD) patients after surgery. Methods　A total of 403 patients (403 eyes) with RRD diagnosed in the Department of Ophthalmology of the First Affiliated Hospital of Soochow University from October 2020 to April 2022 were included in this study. Among them, 35 patients underwent the scleral buckling, 79 patients underwent the pars plana vitrectomy (PPV) + intravitreal gas tamponade, 222 patients underwent the PPV + intravitreal silicone oil tamponade, and 67 patients underwent the PPV + vitreous silicone oil tamponade + silicone oil removal. The postoperative follow-up lasted for at least 3 months. Risk factors affecting one-time retinal reattachment after RRD surgery were analyzed by univariate and multivariate Logistic analyses, and Logistic regression was applied to construct a risk prediction model. Results　Among the 403 eyes with RRD, 369 eyes had retinal reattachment on the first try, and 34 eyes did not, with a one-time reattachment rate of 91.6%. The univariate analysis showed that the differences in axial length (AL), surgical approach, location of the tear, and size of the tear between patients with one-time retinal reattachment and those without reattachment were statistically significant (all P＜0.05). From the regression equation, it was found that the risk of non-reattachment after RRD surgery of patients with an AL ≥ 26 mm was 4.248 times higher than those with an AL＜26 mm (P＜0.05). The multivariate Logistic regression analysis showed that AL, location of the tear, size of the tear, and surgical approach were risk factors for non-reattachment after RRD surgery (all P＜0.05). The Hosmer-Lemeshow test yielded P=0.165. The results of the receiver operating characteristic curve analysis showed that the area under the curve to predict whether retinal re-detachment occurs after RRD surgery was 0.892 (95% CI: 0.832-0.953), and the sensitivity and specificity were 79.4% and 87.3%, respectively (P＜0.05).Conclusion　AL is an independent risk factor for retinal re-detachment after RRD surgery. The prediction model constructed based on AL, location of the tear, size of the tear, and the surgical method can accurately predict whether retinal detachment will occur after RRD surgery.

参考文献/References:

［1］　SULTAN Z N,AGOROGIANNIS E I,IANNETTA D,STEEL D,SANDINHA T.Rhegmatogenous retinal detachment:a review of current practice in diagnosis and management［J］.BMJ Open Ophthalmol,2020,5(1):e000474.
［2］　BECHRAKIS N E,DIMMER A.Rhegmatogenous retinal detachment:Epidemiology and risk factors［J］.Ophthalmologe,2018,115(2):163-178.
［3］　ULLRICH M,ZWICKL H,FINDL O.Incidence of rhegmatogenous retinal detachment in myopic phakic eyes［J］.J Cataract Refract Surg,2021,47(4):533-541.
［4］　TANIHARA H,NEGI A,KAWANO S,ISHIGOUOKA H,UEDA Y,YOSHIDA-SUZUKI S,et al.Axial length of eyes with rhegmatogenous retinal detachment［J］.Ophthalmologica,1993,206(2):76-82.
［5］　SHI J,WU K,WEN H,WEI J,ZONG Y,YU J,et al.Change in axial length after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment［J］.BMC Ophthalmol,2022,22(1):257.
［6］　HUANG C,ZHANG T,LIU J,JI Q,TAN R.Changes in axial length,central cornea thickness,and anterior chamber depth after rhegmatogenous retinal detachment repair［J］.BMC Ophthalmol,2016,16(1):1-6.
［7］　CUSTODIS E.Treatment of retinal detachment by circumscribed diathermal coagulation and by scleral depression in the area of tear caused by imbedding of a plastic implant［J］.Klin Monbl Augenheilkd Augenarztl Fortbild,1956,129(4):476-495.
［8］　MACHEMER R,PAREL J M,BUETTNER H.A new concept for vitreous surgery［J］.Am J Ophthalmol,1972,73(1):1-7.
［9］　WYKOFF C C,SCHWARTZ S G,ADELMAN R A,BRUCKER A J,FLYNN H W Jr.Primary rhegmatogenous retinal detachment repair:evidence supports an individualised approach［J］.Br J Ophthalmol,2015,99(11):1451-1453.
［10］　ADELMAN R A,PARNES A J,DUCOURNAU D.Strategy for the management of uncomplicated retinal detachments:the European vitreo-retinal society retinal detachment study report 1［J］.Ophthalmology,2013,120(9):1804-1808.
［11］　REEVES M G,PERSHING S,AFSHAR A R.Choice of primary rhegmatogenous retinal detachment repair method in US commercially insured and medicare advantage patients,2003-2016［J］.Am J Ophthalmol,2018,196:82-90.
［12］　QUIJANO C,ALKABES M,GOMEZ-RESA M,OLENIK A,VILLANI E,CORCOSTEGUI B.Scleral buckling in phakic uncomplicated primary rhegmatogenous retinal detachment:long-term outcomes［J］.Eur J Ophthalmol,2017,27(2):220-225.
［13］　NISHITSUKA K,KAWASAKI R,YAMAKIRI K,BABA T,KOTO T,YAMASHITA H,et al.Preoperative factors to select vitrectomy or scleral buckling for retinal detachment in microincision vitrectomy era［J］.Graefes Arch Clin Exp Ophthalmol,2020,258(9):1871-1880.
［14］　JABBOUR E,AZAR G,ANTOUN J,KOURIE H,ABDELMASSIH Y,JALKH A.Incidence and risk factors of ocular hypertension following pars Plana vitrectomy and silicone oil injection［J］.Ophthalmologica,2018,240(3):129-134.
［15］　WONG R,LUCA M D,SHUNMUGAM M,WILLIAMSON T,LAIDLAW A,VACCARO V.Visual outcome after removal of silicone oil in patients undergoing retinectomy for complex retinal detachment［J］.Int J Ophthalmol-Chi,2016,9(1):108-110.
［16］　ZHOU C,QIU Q,ZHENG Z.Air versus gas tamponade in rhegmatogenous retinal detachment with inferior breaks after 23-gauge pars Plana vitrectomy［J］.Retina,2015,35(5):886-891.
［17］　SHUNMUGAM M,SHAH A N,HYSI P G,WILLIAMSON T H.The pattern and distribution of retinal breaks in eyes with rhegmatogenous retinal detachment［J］.Am J Ophthalmol,2014,157(1):221-226.
［18］　GOTO T,NAKAGOMI T,IIJIMA H.A comparison of the anatomic successes of primary vitrectomy for rhegmatogenous retinal detachment with superior and inferior breaks［J］.Acta Ophthalmol,2013,91(6):552-556.
［19］　LI K X,CARDUCCI N,MOINUDDIN O,ZHOU Y,MUSCH D C,ZACKS D N,et al.Contemporary management of complex and non-complex rhegmatogenous retinal detachment due to giant retinal tears［J］.Clin Ophthalmol,2021,15:1013-1022.

相似文献/References:

[1]孔祥斌 晏世刚 罗书科 苏鹏.中老年人眼球生物学结构参数的年龄相关性改变[J].眼科新进展,2012,32(7):000.
[2]张建华 王予东 金家岩 石荣先 李彬 晁小蕊.眼压对眼轴长度影响的实验研究[J].眼科新进展,2013,33(9):000.
[3]吴岩 于靖.增生性玻璃体视网膜病变相关蛋白研究进展[J].眼科新进展,2012,32(1):000.
[4]吴震 荆翠红 蔡娟娟 赵丽君 韩九娥 吴化宇 余戎.不同类型高度病理性屈光参差屈光要素分析[J].眼科新进展,2012,32(3):000.
[5]徐静 李雪 胡琦 杨帆 吴琼 王珂萌.超高度近视眼屈光力及眼轴影响因素分析[J].眼科新进展,2012,32(10):000.
[6]赵明慧 贾丽丽 胡萍 吴强.青年近视患者黄斑厚度的相关因素分析[J].眼科新进展,2013,33(10):000.
[7]李美丽,邹海东,庞昆,等. 傅里叶光学相干断层扫描测量上海市宝山区儿童房角相关参数[J].眼科新进展,2014,34(4):341.[doi:10.13389/j.cnki.rao.2014.0092]
[8]董尼娜,王文战.光学相干断层扫描评价孔源性视网膜脱离的玻璃体手术疗效[J].眼科新进展,2014,34(5):451.[doi:10.13389/j.cnki.rao.2014.0123]
　DONG Ni-Na,WANG Wen-Zhan.Evaluation of vitrectomy for rhegmatogenous retinal detachment by optical coherence tomography[J].Recent Advances in Ophthalmology,2014,34(1):451.[doi:10.13389/j.cnki.rao.2014.0123]
[9]李雯,周丹,厉君,等.眼轴长度对健康成年人24h眼压波动的影响[J].眼科新进展,2014,34(10):978.[doi:10.13389/j.cnki.rao.2014.0271]
[10]李斌,牛燕,李超,等.初发性近视患者配戴角膜塑形镜和框架眼镜的疗效观察[J].眼科新进展,2015,35(1):078.[doi:10.13389/j.cnki.rao.2015.0022]
　LI Bin,NIU Yan,LI Chao,et al.Clinical observation on orthokeratology and glasses treatment of onset myopia[J].Recent Advances in Ophthalmology,2015,35(1):078.[doi:10.13389/j.cnki.rao.2015.0022]

备注/Memo

备注/Memo:
苏州市“科教兴卫”青年科技项目（编号：KJXW2020077）；苏州市医疗卫生科技创新项目（编号：SKJY2021015）；苏州市科技发展计划项目（编号：SYSD2020048）；苏州市姑苏卫生人才计划青年拔尖人才项目（编号：GSWS2020014）
更新日期/Last Update: 2024-01-05