摘要
目的分析巩膜外垫压术治疗孔源性视网膜脱离(RRD)的效果及其影响因素。方法回顾性病例系列研究。纳入新乡医学院第三附属医院2020年5月至2024年12月行巩膜外垫压术治疗的RRD 60例(60只眼)。统计所有患者术后视网膜复位率以及术前术后最佳矫正视力(BCVA),依据术后BCVA提高是否≥0.1分为视力预后良好组与视力预后不良组。多因素logistic回归分析影响RRD患者巩膜外垫压术疗效的相关因素,并通过受试者工作特征(ROC)曲线建立RRD患者巩膜外垫压术疗效的风险预测模型。结果60例RRD患者术后视网膜复位成功53例(88.33%,53/60),余下7例复位失败患者经二次手术后2例视网膜复位成功,最终视网膜复位成功率为91.67%(55/60)。术后视力预后良好率为81.67%(49/60),视力预后不良率为18.33%(11/60)。患者术前、术后BCVA分布差异有统计学意义(χ^(2)=13.446,P=0.009)。多因素logistic回归分析发现病程≥7 d(OR=11.304,95%CI:1.342~95.202,P=0.026)、术前BCVA≤0.3(OR=14.500,95%CI:1.718~122.395,P=0.014)、视网膜脱离范围>2个象限(OR=17.550,95%CI:3.263~94.384,P=0.001)、累及黄斑(OR=15.789,95%CI:1.868~133.458,P=0.011)均为影响RRD患者巩膜外垫压术疗效的危险因素。基于以上4项指标构建的RRD患者巩膜外垫压术疗效的风险预测模型曲线下面积(AUC)为0.934,明显高于各指标单独预测的0.705、0.751、0.871、0.893,且Hosmer-Lemeshow检验显示χ^(2)=4.023,P=0.855,表明模型拟合度较好,模型预测价值较高。结论巩膜外垫压术治疗RRD患者能促进视网膜复位,提高视力,且病程、术前BCVA、视网膜脱离象限范围及黄斑累及情况均能影响手术疗效。
Objective To analyze the efficacy of scleral buckling for rhegmatogenous retinal detachment(RRD)and its influencing factors.Methods This was a retrospective case series study.The clinical data of 60 patients(60 eyes)with RRD who underwent scleral buckling at the Third Affiliated Hospital of Xinxiang Medical University between May 2020 and December 2024 were analyzed.The postoperative retinal reattachment rate and changes in best corrected visual acuity(BCVA)were recorded.Patients were divided into good and poor visual prognosis groups based on whether postoperative BCVA improvement was≥0.1.Efficacy-influencing factors were analyzed by multivariate logistic regression.A risk prediction model was established using receiver operating characteristic(ROC)curves.Results The initial postoperative reattachment rate was 88.33%(53/60).Among the remaining 7 patients with failed reattachment,2 cases successfully reattached after secondary surgery,and the final reattachment rate was 91.67%(55/60).The good and poor rate of postoperative visual outcome was 81.67%(49/60)and 18.33%(11/60),respectively.The difference was statistically significant in BCVA before and after surgery.(χ^(2)=13.446,P=0.009).Multivariate logistic regression identified longer disease course(≥7 days)(OR=11.304,95%CI:1.342-95.202,P=0.026),worse preoperative BCVA(≤0.3)(OR=14.500,95%CI:1.718-122.395,P=0.014),greater extent of retinal detachment(>2 quadrants)(OR=17.550,95%CI:3.263-94.384,P=0.001),and macular involvement(OR=15.789,95%CI:1.868-133.458,P=0.011)as independent risk factors for poor outcome.The risk prediction model incorporating these four factors had an area under the curve(AUC)of 0.934,significantly higher than the AUCs for each factor alone(0.705,0.751,0.871,0.893).The Hosmer-Lemeshow test indicated good model fit(χ^(2)=4.023,P=0.855).Conclusion Scleral buckling effectively promotes retinal reattachment and improves visual acuity in RRD patients.Disease course,preoperative BCVA,extent of retinal detachment,and macular involvement are influencing factors for visual prognosis.
作者
李洋
宋影慧
付群
Li Yang;Song Yinghui;Fu Qun(Department of Ophthalmology,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang 453000,China)
出处
《中华眼外伤职业眼病杂志(中英文)》
2025年第10期744-751,共8页
Chinese Journal of Ocular Trauma and Occupational Eye Disease
关键词
巩膜
视网膜穿孔
视网膜脱离
视力
Sclera
Retinal perforations
Retinal detachment
Visual acuity
