摘要
目的探讨影响孔源性视网膜脱离(RRD)患者术后视网膜再次脱离的危险因素。方法选取2020年10月至2022年4月于苏州大学附属第一医院眼科进行检查并确诊为RRD的患者403例403眼作为研究对象,其中行巩膜扣带术35眼,玻璃体切割术(PPV)+玻璃体空气填充79眼,PPV+玻璃体硅油填充222眼,PPV+玻璃体硅油填充+取油术67眼。术后连续随访至少3个月。通过单因素和多因素Logistic分析影响RRD术后视网膜一次性未复位的危险因素,并应用Logistic回归构建风险预测模型。结果本组共369眼术后视网膜一次性复位,34眼未复位,一次性复位率为91.6%。单因素分析结果显示,术后视网膜一次性复位和未复位患者眼轴长度(AL)、手术方式、裂孔位置、裂孔大小差异均有统计学意义(均为P<0.05)。由回归方程可知:AL≥26 mm的患者,RRD术后视网膜一次性未复位发生的风险比AL<26 mm的患者增加了4.248倍(P<0.05)。多因素Logistic回归结果显示,AL、裂孔位置、裂孔大小、手术方式是影响RRD术后视网膜未复位的危险因素(均为P<0.05)。H-L检验P=0.165,ROC分析结果显示,预测RRD术后视网膜是否发生再次脱离的曲线下面积为0.892,95%CI:0.832~0.953,灵敏度和特异度分别为79.4%和87.3%(P<0.05)。结论AL是影响RRD术后视网膜再次脱离的独立危险因素,且由AL、裂孔位置、裂孔大小、手术方式构建的预测模型可较为精准的预测RRD术后视网膜是否发生再次脱离。
Objective To explore the risk factors that may cause recurrent retinal detachment in rhegmatogenous retinal detachment(RRD)patients after surgery.Methods A total of 403 patients(403 eyes)with RRD diagnosed in the Department of Ophthalmology of the First Affiliated Hospital of Soochow University from October 2020 to April 2022 were included in this study.Among them,35 patients underwent the scleral buckling,79 patients underwent the pars plana vitrectomy(PPV)+intravitreal gas tamponade,222 patients underwent the PPV+intravitreal silicone oil tamponade,and 67 patients underwent the PPV+vitreous silicone oil tamponade+silicone oil removal.The postoperative follow-up lasted for at least 3 months.Risk factors affecting one-time retinal reattachment after RRD surgery were analyzed by univariate and multivariate Logistic analyses,and Logistic regression was applied to construct a risk prediction model.Results Among the 403 eyes with RRD,369 eyes had retinal reattachment on the first try,and 34 eyes did not,with a one-time reattachment rate of 91.6%.The univariate analysis showed that the differences in axial length(AL),surgical approach,location of the tear,and size of the tear between patients with one-time retinal reattachment and those without reattachment were statistically significant(all P<0.05).From the regression equation,it was found that the risk of non-reattachment after RRD surgery of patients with an AL≥26 mm was 4.248 times higher than those with an AL<26 mm(P<0.05).The multivariate Logistic regression analysis showed that AL,location of the tear,size of the tear,and surgical approach were risk factors for non-reattachment after RRD surgery(all P<0.05).The Hosmer-Lemeshow test yielded P=0.165.The results of the receiver operating characteristic curve analysis showed that the area under the curve to predict whether retinal re-detachment occurs after RRD surgery was 0.892(95%CI:0.832-0.953),and the sensitivity and specificity were 79.4%and 87.3%,respectively(P<0.05).Conclusion AL is an independent risk factor for retinal re-detachment after RRD surgery.The prediction model constructed based on AL,location of the tear,size of the tear,and the surgical method can accurately predict whether retinal detachment will occur after RRD surgery.
作者
周永莹
卢谦益
ZHOU Yongying;LU Qianyi(Department of Ophthalmology,Children’s Hospital of Wujiang District,Suzhou 215200,Jiangsu Province,China;Department of Ophthalmology,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China)
出处
《眼科新进展》
CAS
北大核心
2024年第1期58-61,75,共5页
Recent Advances in Ophthalmology
基金
苏州市“科教兴卫”青年科技项目(编号:KJXW2020077)
苏州市医疗卫生科技创新项目(编号:SKJY2021015)
苏州市科技发展计划项目(编号:SYSD2020048)
苏州市姑苏卫生人才计划青年拔尖人才项目(编号:GSWS2020014)。
关键词
孔源性视网膜脱离
眼轴长度
复发性视网膜脱离
rhegmatogenous retinal detachment
axial length
recurrent retinal detachment
