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背景: 增殖性玻璃体视网膜病变是裂孔性视网膜脱离手术失败最主要的原因。已知多种危险因子与其有关, 也有报道增殖性玻璃体视网膜病变A、B 级患者手术后增殖性玻璃体视网膜病变加重。但对于玻璃体动态性变化所起的危险作用较少讨论。目的: 分析影响裂孔性视网膜脱离病例巩膜扣带术后复位的玻璃体相关危险因子, 以期提高手术成功率。设计: 回顾性分析。单位: 暨南大学医学院深圳眼科中心, 深圳市眼科医院眼底病科。对象: 选择 1990- 01/1999- 12 在深圳市眼科医院眼底病科行巩膜扣带术的增殖性玻璃体视网膜病变 B 级裂孔性视网膜脱离患者 440 例 449眼, 均签署知情同意书。方法: 应用三面镜检查与 B 型超声波扫描观察患者玻璃体情况及其与视网膜裂孔、视网膜的关系。观察分析玻璃体变化影响手术成功的危险因子。玻璃体病变与玻璃体后脱离经 B 型超声波扫描确认。玻璃体病变程度分为 5 组: 正常玻璃体组、玻璃体液化组、玻璃体浓缩组、玻璃体牵引组及玻璃体混合性病变组。玻璃体后界膜变化分为 3 组: 无玻璃体后脱离组, 不完全性玻璃体后脱离组及完全性玻璃体后脱离组。视网膜脱离复位≥ 6 个月为解剖复位成功。主要观察指标: ①手术视网膜复位成功率。②视网膜脱离解剖复位失败的危险因子。结果: 连续随访 6 个月以上及病历记录、临床观察资料符合要求者 426例 435 眼。①巩膜扣带术后 394 眼(90.6%) 首次手术视网膜复位; 再次手术成功 39 眼, 总计 433 眼(99.5%) 视网膜复位。平均随访(41.1±18.3)个月。②玻璃体状态中与视网膜脱离解剖复位失败有关的危险因子包括玻璃体浓缩、玻璃体牵引以及 2 种或 2 种以上的混合性状态。③玻璃体与视网膜界面的关系中与视网膜脱离解剖复位失败有关的危险因子包括不完全性玻璃体后脱离和完全性玻璃体后脱离。结论: 玻璃体状态与玻璃体后界面变化是影响裂孔性视网膜脱离巩膜扣带术复位成功的危险因子, 手术前了解其改变很重要。
BACKGROUND: Proliferative vitreoretinopathy is the most common cause of surgical failure of retinal detachment. Known a variety of risk factors related to it, there are also reports of proliferative vitreoretinopathy grade A, B patients with proliferative vitreoretinopathy after exacerbations. However, there is less discussion on the dangerous role of vitreous body dynamics. Objective: To analyze the related risk factors of vitreous in the patients with retinal detachment after scleral buckling surgery in order to improve the success rate of surgery. Design: Retrospective analysis. Unit: Shenzhen Eye Center, Jinan University School of Medicine, Eye Hospital, Shenzhen Eye Hospital. PARTICIPANTS: Forty-four eyes of 449 eyes with proliferative vitreoretinopathy and grade B retinal detachment under scleral buckling surgery at Department of Ophthalmology, Shenzhen Eye Hospital were selected from January 1990 to December 1999, all of whom signed informed consent. Methods: The vitreous and its relationship with retinal breaks and retina were observed by three-mirror and B-mode ultrasound. Observe and analyze the risk factors of success of vitreous surgery. Vitreous lesions and posterior vitreous detachment confirmed by B-mode ultrasound scan. The degree of vitreous lesions were divided into 5 groups: normal vitreous group, vitreous liquefaction group, vitreous body concentration group, vitreous traction group and vitreous mixed lesion group. Vitreous posterior membrane changes are divided into three groups: no posterior vitreous detachment group, incomplete posterior vitreous detachment group and complete posterior vitreous detachment group. Retinal detachment reduction ≥ 6 months for the successful anatomic reduction. MAIN OUTCOME MEASURES: ① The success rate of surgical retina reduction. ② retinal detachment failure to restore anatomical risk factors. Results: Continuous follow-up of more than 6 months and medical records, clinical observation of 426 cases meet the requirements of 435 eyes. ① Retinal reattachment was performed in 394 eyes (90.6%) after scleral buckling operation; 39 eyes underwent reoperation, a total of 433 eyes (99.5%) had retinal reattachment. The average follow-up (41.1 ± 18.3) months. ② vitreous state and retinal detachment anatomic reduction failure-related risk factors include vitreous concentration, vitreous traction and two or more than two mixed state. ③ The relationship between the vitreous and the retina interface and anatomical retinal detachment failure failure-related factors include incomplete posterior vitreous detachment and complete posterior vitreous detachment. CONCLUSION: The changes of vitreous state and posterior vitreous interface are the risk factors for the success of retinal detachment and scleral buckling. It is very important to understand the changes before surgery.