本文選題：視網(wǎng)膜脫離　切入點(diǎn)：陳舊性　出處：《浙江大學(xué)》2011年碩士論文

【摘要】：目的：分析陳舊性孔源性視網(wǎng)膜脫離的臨床相關(guān)因素以及手術(shù)治療效果。設(shè)計(jì)：回顧性病例對(duì)照研究。對(duì)象：我院自2008年6月至2010年11月視網(wǎng)膜病組所收治入院的同一術(shù)者連續(xù)103例(103眼)原發(fā)性RRD患者。入選標(biāo)準(zhǔn)：有癥狀的原發(fā)性視網(wǎng)膜脫離,直接或間接眼底鏡下明確視網(wǎng)膜裂孔和視網(wǎng)膜脫離范圍超過赤道后2DD以上。排除標(biāo)準(zhǔn)：繼發(fā)性視網(wǎng)膜脫離(如滲出性、牽引性及外傷性等),黃斑裂孔引起的視網(wǎng)膜脫離,復(fù)發(fā)性視網(wǎng)膜脫離,無癥狀性視網(wǎng)膜脫離(包括臨床及亞臨床型視網(wǎng)膜脫離),既往有玻璃體視網(wǎng)膜手術(shù)史,臨床數(shù)據(jù)資料不全患者。分組：研究組符合以下兩條標(biāo)準(zhǔn)任何一條(共30眼)：視網(wǎng)膜脫離伴有視網(wǎng)膜下限局線；明確的視力下降或視野遮擋3月以上并與眼底檢查結(jié)果相符合。不符合上述兩條標(biāo)準(zhǔn)者組成對(duì)照組(共73眼)；陳舊性視網(wǎng)膜脫離按術(shù)后視力是否提高進(jìn)一步分組分析。手術(shù)選擇：根據(jù)患者視網(wǎng)膜脫離范圍、裂孔分布、玻璃體混濁、視網(wǎng)膜增殖等情況以及術(shù)者經(jīng)驗(yàn)和熟練程度分別選擇玻璃體切割術(shù)或者鞏膜扣帶術(shù),其中前者根據(jù)晶體混濁程度部分聯(lián)合白內(nèi)障手術(shù)。研究指標(biāo)：分析性別、年齡、眼別、術(shù)前矯正視力、視網(wǎng)膜脫離范圍(累及象限數(shù))、裂孔類型、位置、數(shù)目、大小、眼軸長度及有無人工晶體等與陳舊性視網(wǎng)膜脫離形成相關(guān)因素；術(shù)后比較隨訪時(shí)間、視網(wǎng)膜復(fù)位及矯正視力提高況及分析影響因素；分析術(shù)后未復(fù)位原因等。數(shù)據(jù)分析：使用統(tǒng)計(jì)軟件SAS9.1,單因素分析計(jì)量資料采用T檢驗(yàn)或Wilcoxon兩樣本檢驗(yàn),計(jì)數(shù)資料以卡方檢驗(yàn)或者Fisher精確概率法作成組比較；多因素分析采用Logistic回歸分析。結(jié)果：陳舊性孔源性視網(wǎng)膜脫離形成的獨(dú)立危險(xiǎn)因素：萎縮性裂孔(OR=7.997p=0.007),下方裂孔(OR=14.127p0.0001),術(shù)前矯正視力(OR=1.636 p0.0722);兩組視力提高率及視網(wǎng)膜復(fù)位率均無顯著性差異(p值分別為0.1245、0.7190, Fisher精確概率法)；陳舊性視網(wǎng)膜脫離視力提高與患者病史呈顯著相關(guān)性(p=0.0345Wilcoxon兩樣本檢驗(yàn))結(jié)論：萎縮性裂孔、下方裂孔、術(shù)前矯正視力為陳舊性孔源性視網(wǎng)膜脫離形成的獨(dú)立危險(xiǎn)因素；陳舊性視網(wǎng)膜脫離術(shù)后視力提高及復(fù)位率與非陳舊性相仿,影響其視力提高主要因素為病史的長短。
[Abstract]:Objective: to analyze the clinical related factors and the effect of surgical treatment of old rhegmatogenous retinal detachment. Design: retrospective case-control study. Participants: admitted to our hospital from June 2008 to November 2010. Patients with primary RRD. Inclusion criteria: symptomatic primary retinal detachment. Under direct or indirect fundus microscopy, it is clear that the retinal tear and retinal detachment extend beyond the equatorial 2DD. Exclusion criteria: secondary retinal detachment (e.g. exudation, traction and trauma, retinal detachment caused by macular holes, etc.). Recurrent retinal detachment, asymptomatic retinal detachment (including clinical and subclinical retinal detachment, previous vitreoretinal surgery), Patients with incomplete clinical data. Group: the study group met any of the following two criteria (30 eyes): retinal detachment with retinal lower limit line; Clear visual acuity or visual field occlusion more than 3 months and consistent with the results of fundus examination. Those who did not meet the above two criteria constituted a control group (73 eyes in total; old retinal detachment according to whether postoperative visual acuity improved or not further group. Analysis. Choice of surgery: according to the range of retinal detachment, The distribution of holes, vitreous opacity, retinal proliferation, and the experience and proficiency of the operators were selected for vitrectomy or scleral buckling, respectively. The former was combined with cataract surgery according to the degree of lens opacity. Study measures: sex, age, eye type, preoperative corrected visual acuity, retinal detachment range (involving quadrant, type, location, number, size) of retinal detachment, The axial length and intraocular lens were associated with the formation of old retinal detachment, the postoperative follow-up time, the improvement of retinal reattachment and corrected visual acuity were compared and the influencing factors were analyzed. Data analysis: statistical software SAS9.1 was used, single factor analysis data were measured by T test or Wilcoxon two-sample test, counting data were compared by chi-square test or Fisher accurate probability method. Multivariate analysis was performed with Logistic regression analysis. Results: the independent risk factors for the formation of old rhegmatogenous retinal detachment were as follows: atrophic hiatus 7.997p0. 007, ORP 14.127p0.0001, preoperative corrected visual acuity OR1.636 p0.0722, the improvement rate of visual acuity and the rate of retina reattachment in both groups. There was no significant difference (P = 0.1245 鹵0.7190, Fisher accurate probability method). There was a significant correlation between the improvement of visual acuity in old retinal detachment and the patient's history. Conclusion: atrophic hiatus was found in the atrophic hole, and there was a significant correlation between the visual acuity of the old retinal detachment and the patient's history. The preoperative corrected visual acuity was an independent risk factor for the formation of old rhegmatogenous retinal detachment, and the postoperative visual acuity and reattachment rate of the old retinal detachment were similar to those of the non-old ones, and the main factors affecting the improvement of visual acuity were the length of the history.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R779.6

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本文編號(hào)：1675613