發(fā)布時間：2018-11-24 08:59

【摘要】：目的:比較玻璃體切割(Pars plana vitrectomy,PPV)聯(lián)合白內(nèi)障超聲乳化吸出手術(shù)中保留晶狀體環(huán)形前囊膜和后囊膜治療孔源性視網(wǎng)膜脫離(Rhegmatogenous retinal detachment,RRD)合并年齡相關(guān)性白內(nèi)障的療效差異。方法:回顧性分析2014年12月至2016年6月在廣西壯族自治區(qū)人民醫(yī)院眼科確診為RRD合并年齡相關(guān)性白內(nèi)障并行23G玻璃體切割、硅油填充聯(lián)合白內(nèi)障超聲乳化吸出手術(shù)治療的58例患者58眼的病例資料。其中,A組28只眼,保留晶狀體環(huán)形前囊膜;B組30只眼,保留晶狀體后囊膜。所有患眼術(shù)后3~4個月均行玻璃體腔硅油取出聯(lián)合人工晶狀體二期植入手術(shù)。對比分析手術(shù)前及手術(shù)后兩組患者的視網(wǎng)膜復位率、最佳矯正視力(Best corrected visual acuity,BCVA)、玻璃體腔硅油取出聯(lián)合人工晶狀體二期植入手術(shù)時間及手術(shù)并發(fā)癥的差異。所有患者玻璃體腔硅油取出聯(lián)合人工晶狀體二期植入手術(shù)后至少隨訪3個月。結(jié)果:(1)保留晶狀體環(huán)形前囊膜組和保留晶狀體后囊膜組的術(shù)后一次性視網(wǎng)膜復位率分別為89.28%和86.66%,兩組患者術(shù)后一次性視網(wǎng)膜復位率差異無統(tǒng)計學意義(P0.05)。(2)兩組患者末次隨訪的最小分辨角對數(shù)(log MAR)BCVA與術(shù)前比較差異均有統(tǒng)計學意(P0.05),兩組術(shù)后logMAR BCVA均好于術(shù)前。兩組患者末次隨訪的logMAR BCVA比較差異無統(tǒng)計學意義(P0.05);兩組患者術(shù)后視力提高率相比差異無統(tǒng)計學意義(P0.05);兩組患者術(shù)后脫盲率相比差異有統(tǒng)計學意義(P0.05),保留環(huán)形前囊膜組術(shù)后脫盲率優(yōu)于保留后囊膜組。(3)兩組患者行玻璃體腔硅油取出聯(lián)合人工晶狀體二期植入手術(shù)的手術(shù)時間比較,差異有統(tǒng)計學意義(P0.05),保留環(huán)形前囊膜組手術(shù)時間短于保留后囊膜組。(4)兩組患者術(shù)后復發(fā)性視網(wǎng)膜脫離、早期高眼壓、角膜水腫、角膜上皮缺損、前房滲出和前房積血的發(fā)生率比較,差異均無統(tǒng)計學差異(P0.05)。此外,保留晶狀體后囊膜組術(shù)后出現(xiàn)6例后囊渾濁(Posterior capsule opacification,PCO),予Nd:YAG激光晶狀體后囊切開術(shù)治療后BCVA改善。結(jié)論:PPV聯(lián)合白內(nèi)障超聲乳化吸出手術(shù)中保留晶狀體環(huán)形前囊膜可在保證RRD合并年齡相關(guān)性白內(nèi)障治療效果的同時,提高患者術(shù)后的脫盲率,有效預防PCO并縮短玻璃體腔硅油取出聯(lián)合人工晶狀體二期植入手術(shù)的時間。
[Abstract]:Objective: to compare the effects of vitrectomy (Pars plana vitrectomy,PPV) combined with phacoemulsification in the treatment of rhegmatogenous retinal detachment (Rhegmatogenous retinal detachment,) by reserving the annular anterior capsule of lens and posterior capsule in the treatment of rhegmatogenous retinal detachment. RRD) and age-related cataract. Methods: from December 2014 to June 2016, the diagnosis of RRD with age-related cataract and 23 G vitrectomy in ophthalmology of Guangxi Zhuang Autonomous region people's Hospital were retrospectively analyzed. Data of 58 eyes of 58 patients with phacoemulsification combined with silicone oil filling and phacoemulsification. In group A, the annular anterior capsule was preserved in 28 eyes, and in group B, the posterior capsule was preserved in 30 eyes. Vitreous silicone oil extraction combined with IOL implantation was performed in all eyes 3 ~ 4 months after operation. The retinal reattachment rate, best corrected visual acuity (Best corrected visual acuity,BCVA), vitreous silicone oil extraction and intraocular lens implantation were compared between the two groups before and after surgery. All patients were followed up for at least 3 months after vitreous silicone oil extraction and intraocular lens implantation. Results: (1) the one-off retinal reattachment rates were 89.28% and 86.66% in the anterior capsule group and the posterior capsule group, respectively. There was no significant difference in the rate of retinal reattachment between the two groups (P0.05). (2). The lognormal resolution angle (log MAR) BCVA) of the last follow-up in the two groups was significantly different from that before the operation (P0.05). LogMAR BCVA in both groups was better than that before operation. There was no significant difference in logMAR BCVA between the two groups at the last follow-up (P0.05), and there was no significant difference in the rate of postoperative visual acuity between the two groups (P0.05). There was significant difference between the two groups (P0.05). (3) the two groups of patients with vitreous silicone oil extraction combined with intraocular lens implantation operation time comparison, the difference was statistically significant (P0.05). (4) the incidence of recurrent retinal detachment, early intraocular pressure, corneal edema, corneal epithelial defect, anterior chamber exudation and hyphema were significantly shorter in the annular anterior capsule group than in the posterior capsule preservation group. (4) the incidence of recurrent retinal detachment, early intraocular hypertension, corneal edema, corneal epithelial defect, anterior chamber exudation and hyphema were compared between the two groups. The differences were not statistically significant (P0.05). In addition, there were 6 cases of posterior capsular opacification (Posterior capsule opacification,PCO) in the posterior capsule group. BCVA was improved after Nd:YAG laser posterior capsulorotomy. Conclusion: PPV combined with phacoemulsification can keep the annular anterior capsule of the lens in the phacoemulsification surgery to ensure the effect of RRD combined with age-related cataract at the same time to improve the rate of blindness reduction after operation. To prevent PCO and shorten the time of vitreous silicone oil extraction combined with IOL implantation.
【學位授予單位】：廣西中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R779.6

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