目的探讨孔源性视网膜脱离(RRD)玻璃体切割术后黄斑下积液(SMF)发生的相关因素。
方法采用回顾性系列病例观察研究方法，纳入2017年5月至2019年8月于郑州大学第一附属医院接受23G玻璃体切割联合硅油填充术治疗的RRD患者103例103眼，其中男55例55眼，女48例48眼；年龄17~77岁，平均(48.65±15.80)岁。术前及术后1个月、3个月应用光相干断层扫描(OCT)观察黄斑部形态，并根据术后1个月OCT检查结果将患者分为SMF组和无SMF组。分析并比较各组患者年龄、性别、发病时间、眼轴长度、术前视网膜脱离范围(是否累及黄斑)、是否由下方视网膜裂孔引起的视网膜脱离、术中视网膜下液放液方式及手术前后不同时间点最佳矫正视力(BCVA)等。并根据患者意愿分别对3眼进行FFA检查，对2眼进行微视野检查。采用二元多因素Logistic回归分析RRD患者玻璃体切割术后SMF发生的危险因素。
结果术后经眼底检查及眼部超声检查均提示视网膜完全解剖复位。103眼中11眼发生SMF，发生率为10.7%。微视野检查结果显示，2例SMF患者术后3个月视功能较术后1个月均有下降。SMF患者术后1个月及3个月BCVA较术后无SMF者差，差异均有统计学意义(均 P<0.05)。Logistic回归分析结果显示，术前RRD累及黄斑区、下方视网膜裂孔引起的RRD是术后SMF发生的危险因素( OR＝6.401， P＝0.041； OR＝19.819， P＝0.005)，年龄增长、术中造放液孔释放视网膜下液是SMF发生的保护因素( OR＝0.939， P＝0.016； OR＝0.123； P＝0.040)。
结论玻璃体切割联合硅油填充术治疗RRD，术前视网膜脱离波及黄斑区及由下方裂孔引起的视网膜脱离是术后SMF发生的危险因素，而年龄增长、术中通过放液孔放液可能会减少术后SMF的发生。玻璃体切割术后SMF可能影响患者视力的恢复。
ObjectiveTo investigate the factors related to the occurrence of submacular fluid (SMF) after pars plana vitrectomy (PPV) in the treatment of rhegmatogenous retinal detachment (RRD).
MethodsA retrospective case series observational study was performed.A total of 103 patients (103 eyes) with RRD who underwent 23G vitrectomy combined with silicone oil tamponade in The First Affiliated Hospital of Zhengzhou University from May 2017 to August 2019 were included.There were 55 males and 48 females, aged from 17 to 77, with an average of (48.65±15.80) years.The macular morphology was observed by optical coherence tomography (OCT) before surgery and 1 month and 3 months after surgery.The patients were divided into SMF group and no SMF group according to OCT results at 1 month after surgery.Clinical data were compared and analyzed, including age, gender, duration of symptoms, axial length, the preoperative status of macula (on or off), retinal detachment caused by inferior retinal break or not, the way to drain subretinal fluid intraoperative, best corrected visual acuity (BCVA). FFA was performed in 3 eyes and microperimeter examination in 2 eyes with SMF according to patients' willingness.A multivariate binary Logistic regression was used to analyze the risk factors of SMF after vitrectomy in RRD patients.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2020-KY-334). Written informed consent was obtained from each subject prior to surgery.
ResultsPostoperative optical fundus examination and ocular ultrasound indicated that retinas of all eyes were completely anatomically reattached.There were 10.7% (11/103) of eyes developed SMF.The microperimeter examination results of 2 patients showed that their visual functions were worse at 3 months than those at 1 month after operation.The BCVA of patients with SMF at 1 month and 3 months after operation were worse than those without SMF, and the differences were statistically significant (both at P<0.05). Logistic regression analysis showed that macula-off RD before surgery and RD caused by inferior break of retina were risk factors for the occurrence of SMF (OR=6.401, P=0.041; OR=19.819, P=0.005), while the increasing age and the drainage of subretinal fluid through draining hole were protective factors (OR=0.939, P=0.016; OR=0.123, P=0.040).
ConclusionsMacula-off RD before surgery, and RD caused by inferior break of retina may be the risk factors of SMF after PPV combined with silicone oil tamponade for RRD.Nevertheless, the increasing age and the drainage of subretinal fluid through draining hole may decrease the occurrence of SMF.And SMF after PPV may delay visual recovery.
董怡辰,孙早荷,万光明. 孔源性视网膜脱离玻璃体切割术后黄斑下积液发生及相关因素分析[J]. 中华实验眼科杂志,2021,39(03)：243-248.
DOI:10.3760/cma.j.cn115989-20200428-00293版权归中华医学会所有。
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万光明：论文修改、经费支持；董怡辰：采集资料、数据整理与分析、论文撰写；孙早荷：采集资料、数据整理
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