鞏膜扣帶治療孔源性視網(wǎng)膜脫離術(shù)后視網(wǎng)膜色素上皮脫離的臨床分析
發(fā)布時間：2018-08-20 16:25
【摘要】： 研究目的： 孔源性視網(wǎng)膜脫離(rhegmatogenous retinal detachment, RRD)發(fā)生在視網(wǎng)膜裂孔形成的基礎(chǔ)上,由液化的玻璃體經(jīng)裂孔進(jìn)入視網(wǎng)膜神經(jīng)上皮層與色素上皮層之間,造成二者分離。由于脈絡(luò)膜對視網(wǎng)膜外層的營養(yǎng)供應(yīng)被阻斷,尤其累及黃斑后視力急劇減退,是嚴(yán)重的致盲性眼病。 RRD手術(shù)目的在于尋找并封閉所有的視網(wǎng)膜裂孔,消除和緩解玻璃體視網(wǎng)膜牽拉,促使視網(wǎng)膜神經(jīng)上皮層與色素上皮層貼附。目前常用的鞏膜扣帶術(shù)包括鞏膜加壓術(shù)、鞏膜環(huán)扎術(shù),并聯(lián)合放視網(wǎng)膜下積液和玻璃體腔注射液體或氣體,對不伴有嚴(yán)重增殖性玻璃體視網(wǎng)膜病變(proliferative vitreoretinopathy,PVR)的病例,其手術(shù)成功率能達(dá)到95%以上。隨著玻璃體顯微手術(shù)的發(fā)展,一些復(fù)雜視網(wǎng)膜脫離的治療也取得了很大改觀。 但是RRD術(shù)后并發(fā)癥嚴(yán)重影響術(shù)后視功能的恢復(fù),甚至威脅眼球的存亡。本文通過分析109例接受鞏膜扣帶術(shù)治療的RRD患者的臨床資料,總結(jié)鞏膜扣帶治療RRD術(shù)后的并發(fā)癥。并報道17例術(shù)后視網(wǎng)膜色素上皮(retinal pigment epithelium, RPE)脫離,探討鞏膜扣帶術(shù)后發(fā)生RPE脫離的機制及防治措施。 研究方法： 1.病例：收集2008-07-01至2009-10-31在山東大學(xué)齊魯醫(yī)院眼科行鞏膜扣帶術(shù)的107例RRD患者共109只眼。其中男性患者51例,女性56例,最小年齡9歲,最大78歲。 2.手術(shù)分類：根據(jù)手術(shù)加壓方式分為以下幾種：(A1)鞏膜環(huán)扎術(shù)18例,(A2)垂直角膜緣放置壓墊53例,(A3)平行角膜緣放置壓墊38例。根據(jù)是否放視網(wǎng)膜下液分為：(B1)放視網(wǎng)膜下液95例,(B2)不放視網(wǎng)膜下液14例。 3.隨訪：采取門診方式對患者進(jìn)行隨訪,時間分別為：術(shù)后0.5個月103例、1.5個月97例、3個月89例、6個月77例。主訴視物變形者,經(jīng)散瞳查眼底及光學(xué)相干斷層成像(optical coherence tomography, OCT)檢查,確診發(fā)生RPE脫離的,給予口服強的松治療。 4.觀察指標(biāo)：對隨診病人查最佳矯正視力、散瞳查眼底、眼科B超檢查,主訴視物變形者或高度懷疑發(fā)生RPE脫離者行OCT檢查,必要時行眼底熒光血管造影(fundus fluorescein angiography, FFA)或吲哚青綠血管造影(indocyanine green angiography, ICGA)。所獲數(shù)據(jù)采用SPSS (Statistics17.0)軟件包進(jìn)行統(tǒng)計分析,以p0.05作為差異有統(tǒng)計學(xué)意義的檢驗標(biāo)準(zhǔn)。根據(jù)統(tǒng)計結(jié)果,分析RPE脫離的患病率是否有年齡、性別及手術(shù)方式的統(tǒng)計學(xué)差異。確診發(fā)生RPE脫離的患者,口服強的松治療。并對激素治療效果進(jìn)行評估。 結(jié)果： 一、基本資料： 本組入選病例包括107例RRD患者共109只眼。 其中男性患者51例,女性56例。最小年齡9歲,最大78歲。根據(jù)患者主訴,發(fā)病時間從3天至1年余不等。 術(shù)前視力0.3者78例,0.3～0.6者27例,0.6者4例。 按照美國視網(wǎng)膜學(xué)會命名委員會的PVR分級標(biāo)準(zhǔn)(1983),A級24例,B級41例,C1級30例,C2級14例。 二、網(wǎng)膜復(fù)位情況：術(shù)后0.5個月網(wǎng)膜復(fù)位90例、1.5個月復(fù)位85例、3個月復(fù)位83例、6個月復(fù)位77例。 三、術(shù)后視力： 隨訪0.5個月103例、1.5個月97例、3個月89例、6個月77例,最佳矯正視力平均數(shù)分別為0.4146、0.4670、0.4933、0.5312。 四、并發(fā)癥： 術(shù)后屈光改變(相差1.OOD以上)49(44.95%)例,OCT查見黃斑區(qū)結(jié)構(gòu)變化：黃斑區(qū)水腫19(17.43%)例、黃斑前膜5(0.92%)例、RPE脫離17(15.60%)例。術(shù)后0.5月神經(jīng)上皮層脫離12(11.65%)例。 五、RPE脫離： 術(shù)后17例患者發(fā)生RPE脫離。統(tǒng)計分析顯示：鞏膜扣帶治療RRD術(shù)后的RPE脫離好發(fā)于青壯年(年齡中位數(shù)30.0000歲),平行角膜緣較垂直角膜緣放置壓墊者居多(p=0.0010.0125),不放液多于放液組(p=0.0010.05),但無性別差異(p=0.1250.05)。經(jīng)糖皮質(zhì)激素治療后視力可得到一定程度的提高,但長期療效有待進(jìn)一步觀察。 結(jié)論： (1)鞏膜扣帶治療孔源性視網(wǎng)膜脫離術(shù)后可發(fā)生RPE脫離,推測可能與手術(shù)操作造成脈絡(luò)膜循環(huán)障礙及術(shù)后炎癥因子釋放有關(guān)。(2)鞏膜扣帶術(shù)后RPE脫離好發(fā)于青壯年,以平行角膜緣放置壓墊者居多,不放液多于放液,無性別差異。(3)激素治療有效。
[Abstract]:Research purposes:
Rhegmatogenous retinal detachment (RRD) occurs on the basis of retinal hiatus formation. The liquefied vitreous body enters the retinal neuroepithelial layer and the retinal pigment epithelial layer through the retinal hiatus, resulting in the separation of the two. The choroidal nutrient supply to the outer retinal layer is blocked, especially after macular involvement. Dramatic decline is a serious blinding eye disease.
RRD surgery aims at finding and closing all retinal holes, eliminating and alleviating vitreoretinal traction, and promoting the attachment of retinal neuroepithelium to the pigment epithelium. Currently commonly used scleral buckling surgery includes scleral compression, scleral ligation, and combined release of subretinal effusion and vitreous cavity injection of body or gas, right With the development of vitreous microsurgery, the treatment of complicated retinal detachment has been improved greatly.
However, the postoperative complications of RRD seriously affect the recovery of visual function, even threaten the survival of the eyeball. This paper summarizes the complications of scleral buckling for RRD by analyzing the clinical data of 109 patients with RRD who received scleral buckling. 17 cases of postoperative retinal pigment epithelium (RPE) detachment and exploration were reported. To discuss the mechanism and prevention measures of RPE detachment after scleral buckling surgery.
Research methods:
1. Case: A total of 109 eyes of 107 RRD patients who underwent scleral buckling from July 2008 to October 2009 in Qilu Hospital of Shandong University were collected.
2. Operative classification: According to the way of compression, there were 18 cases of scleral cerclage, (A2) 53 cases of vertical corneal limbus, and (A3) 38 cases of parallel corneal limbus.
3. Follow-up: 103 patients were followed up at 0.5 months, 97 patients at 1.5 months, 89 patients at 3 months and 77 patients at 6 months after operation. Patients complaining of visual deformity were diagnosed with RPE detachment by mydriasis and optical coherence tomography (OCT).
4. Observation indicators: Optimal corrected visual acuity, mydriasis, fundus examination, B-ultrasonography, OCT examination in patients with deformed vision or highly suspected RPE detachment, fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA) if necessary. Data were analyzed by SPSS (Statistics 17.0) software package, and P0.05 was used as the test standard of statistical significance. According to the statistical results, the prevalence of RPE detachment was analyzed whether there were statistical differences in age, sex and surgical methods. Assessment.
Result:
First, basic information:
This group included 107 patients with RRD and 109 eyes.
Among them, 51 were male and 56 were female. The youngest was 9 years old and the oldest was 78 years old.
Preoperative visual acuity was 0.3 in 78 cases, 0.3 to 0.6 in 27 cases, and 0.6 cases in 4 cases.
According to the American Retinal Society Nomenclature Committee (1983), there were 24 cases of grade A, 41 cases of grade B, 30 cases of grade C1 and 14 cases of grade C2.
Second, omentum reduction: 0.5 months after surgery, omentum reduction in 90 cases, 1.5 months in 85 cases, 3 months in 83 cases, 6 months in 77 cases.
Three, postoperative visual acuity:
103 cases were followed up for 0.5 months, 97 cases for 1.5 months, 89 cases for 3 months and 77 cases for 6 months. The average best corrected visual acuity was 0.4146, 0.4670, 0.4933 and 0.5312, respectively.
Four, complications:
There were 49 (44.95%) cases with refractive changes (the difference was more than 1.OOD), 19 (17.43%) cases with macular edema, 5 (0.92%) cases with macular anterior membrane, and 17 (15.60%) cases with RPE detachment.
Five, RPE departure:
RPE detachment occurred in 17 patients after scleral buckling for RRD. Statistical analysis showed that RPE detachment was predominant in young adults (median age 30.0000 years). The incidence of RPE detachment was higher in parallel corneal limbus than that in vertical corneal limbus (p = 0.0010.0125). There was no gender difference (p = 0.1250.05). After treatment, the visual acuity can be improved to a certain extent, but the long-term effect needs further observation.
Conclusion:
(1) RPE detachment may occur after scleral buckling for rhegmatogenous retinal detachment, which may be related to choroidal circulation disturbance caused by operation and postoperative inflammatory factors release. (2) RPE detachment after scleral buckling occurs frequently in young adults, and most of them place pressure pads parallel to corneal limbus, without drainage more than drainage, without gender difference. (3) Hormone therapy. The treatment is effective.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R774.12
本文編號：2194262
[Abstract]:Research purposes:
Rhegmatogenous retinal detachment (RRD) occurs on the basis of retinal hiatus formation. The liquefied vitreous body enters the retinal neuroepithelial layer and the retinal pigment epithelial layer through the retinal hiatus, resulting in the separation of the two. The choroidal nutrient supply to the outer retinal layer is blocked, especially after macular involvement. Dramatic decline is a serious blinding eye disease.
RRD surgery aims at finding and closing all retinal holes, eliminating and alleviating vitreoretinal traction, and promoting the attachment of retinal neuroepithelium to the pigment epithelium. Currently commonly used scleral buckling surgery includes scleral compression, scleral ligation, and combined release of subretinal effusion and vitreous cavity injection of body or gas, right With the development of vitreous microsurgery, the treatment of complicated retinal detachment has been improved greatly.
However, the postoperative complications of RRD seriously affect the recovery of visual function, even threaten the survival of the eyeball. This paper summarizes the complications of scleral buckling for RRD by analyzing the clinical data of 109 patients with RRD who received scleral buckling. 17 cases of postoperative retinal pigment epithelium (RPE) detachment and exploration were reported. To discuss the mechanism and prevention measures of RPE detachment after scleral buckling surgery.
Research methods:
1. Case: A total of 109 eyes of 107 RRD patients who underwent scleral buckling from July 2008 to October 2009 in Qilu Hospital of Shandong University were collected.
2. Operative classification: According to the way of compression, there were 18 cases of scleral cerclage, (A2) 53 cases of vertical corneal limbus, and (A3) 38 cases of parallel corneal limbus.
3. Follow-up: 103 patients were followed up at 0.5 months, 97 patients at 1.5 months, 89 patients at 3 months and 77 patients at 6 months after operation. Patients complaining of visual deformity were diagnosed with RPE detachment by mydriasis and optical coherence tomography (OCT).
4. Observation indicators: Optimal corrected visual acuity, mydriasis, fundus examination, B-ultrasonography, OCT examination in patients with deformed vision or highly suspected RPE detachment, fundus fluorescein angiography (FFA) or indocyanine green angiography (ICGA) if necessary. Data were analyzed by SPSS (Statistics 17.0) software package, and P0.05 was used as the test standard of statistical significance. According to the statistical results, the prevalence of RPE detachment was analyzed whether there were statistical differences in age, sex and surgical methods. Assessment.
Result:
First, basic information:
This group included 107 patients with RRD and 109 eyes.
Among them, 51 were male and 56 were female. The youngest was 9 years old and the oldest was 78 years old.
Preoperative visual acuity was 0.3 in 78 cases, 0.3 to 0.6 in 27 cases, and 0.6 cases in 4 cases.
According to the American Retinal Society Nomenclature Committee (1983), there were 24 cases of grade A, 41 cases of grade B, 30 cases of grade C1 and 14 cases of grade C2.
Second, omentum reduction: 0.5 months after surgery, omentum reduction in 90 cases, 1.5 months in 85 cases, 3 months in 83 cases, 6 months in 77 cases.
Three, postoperative visual acuity:
103 cases were followed up for 0.5 months, 97 cases for 1.5 months, 89 cases for 3 months and 77 cases for 6 months. The average best corrected visual acuity was 0.4146, 0.4670, 0.4933 and 0.5312, respectively.
Four, complications:
There were 49 (44.95%) cases with refractive changes (the difference was more than 1.OOD), 19 (17.43%) cases with macular edema, 5 (0.92%) cases with macular anterior membrane, and 17 (15.60%) cases with RPE detachment.
Five, RPE departure:
RPE detachment occurred in 17 patients after scleral buckling for RRD. Statistical analysis showed that RPE detachment was predominant in young adults (median age 30.0000 years). The incidence of RPE detachment was higher in parallel corneal limbus than that in vertical corneal limbus (p = 0.0010.0125). There was no gender difference (p = 0.1250.05). After treatment, the visual acuity can be improved to a certain extent, but the long-term effect needs further observation.
Conclusion:
(1) RPE detachment may occur after scleral buckling for rhegmatogenous retinal detachment, which may be related to choroidal circulation disturbance caused by operation and postoperative inflammatory factors release. (2) RPE detachment after scleral buckling occurs frequently in young adults, and most of them place pressure pads parallel to corneal limbus, without drainage more than drainage, without gender difference. (3) Hormone therapy. The treatment is effective.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R774.12
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 陳峰,鄭海華,施明光,韓真真;光凝與冷凝在孔源性視網(wǎng)膜脫離手術(shù)中的比較[J];臨床眼科雜志;2004年05期
2 樓定華,王競,徐啟彬;彩色多普勒超聲對鞏膜扣帶術(shù)后球后血流動力學(xué)的研究[J];中華超聲影像學(xué)雜志;1998年05期
3 姜荔,馬志中;滲出型老年性黃斑變性視網(wǎng)膜脈絡(luò)膜血管吻合與視網(wǎng)膜色素上皮脫離的關(guān)系分析[J];中華眼底病雜志;2004年05期
相關(guān)博士學(xué)位論文 前1條
1 謝茂松;炎癥因子在前節(jié)內(nèi)眼手術(shù)誘發(fā)血視網(wǎng)膜屏障破壞中的作用及機制研究[D];山東大學(xué);2008年
，本文編號：2194262
本文鏈接：http://sikaile.net/yixuelunwen/yank/2194262.html
最近更新
教材專著
