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白内障手术后视网膜脱离的危险因素:后囊膜破裂的影响

Petousis V, Sallam AA, Haynes RJ, et al.

期刊名称:British Journal of Ophthalmology

卷期:2016年第100卷第11期

马进 主任医师,副教授,眼科中心玻璃体与视网膜病科副主任,研究生导师。中华医学会眼底病学组委员,中国医师协会眼科分会委员。熟练开展多种眼病的诊疗和手术,并积累了丰富的经验。擅长各类复杂的视网膜脱离手术、严重眼外伤的救治、视网膜静脉阻塞手术(动静脉鞘切开、视乳头放射状切开)等,领先创新性开展黄斑水肿、黄斑裂孔的无缝合微创性(25G)玻璃体切割联合曲胺奈德染色、内界膜剥离手术,同时对白内障超生乳化手术,眼眶整形以及视神经管减压手术亦有丰富的经验。已在国内外杂志第一作者发表论文20余篇。有3篇眼底方面的研究论文被SC

该作者的研究主题是白内障手术后造成视网膜脱离的高危因素,术后视网膜脱离的风险在年轻人群中较高,对于有较长眼轴或手术后晶体后囊膜破裂伴玻璃体脱出的患者视网膜的脱离风险也较高,对白内障术前手术方案的制定具有重要意义,是否可考虑后囊破裂后,晶体核掉入玻璃体腔后续处理的相关因素分析。


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摘要

目的:旨在探讨白内障手术后的视网膜脱离(RD)的危险因素,特别是有或没有玻璃体脱出的后囊膜破裂(PCR)危险因素。方法:单中心电子病历数据库研究,对2005年至2014年间连续进行首次白内障手术眼进行了分析。使用Kaplan-Meier曲线和Cox比例风险回归分析进行存活分析以计算相对于RDHR。结果:3个月和7年的RD率分别为0.067%和0.30%,RD时间中值为15个月(平均:18个月,范围:0-84个月)。在单变量模型中,男性的RD风险较高(HR 2.00; 95CI 1.03-3.88; p = 0.03)。与60-80岁的患者相比,<60岁和> 80岁患者的HR分别为5.1295CI 2.60-10.07; p <0.001)和0.1695CI 0.38-0.69; p = 0.01)与23-25mm眼相比,> 25mmHR3.9895CI 1.93-8.20; p <0.001)。400只眼发生PCR2.2%)。玻璃体脱出的PCR眼的RD HR12.8395CI 5.62-29.30; p <0.001)。无玻璃体脱出的PCR眼未发现RD事件。结论:年轻患者和眼轴较长或手术期间有玻璃体脱出的PCR眼的白内障手术后RD风险较高。

Aim To investigate risk factors for retinal detachment (RD) after cataract surgery, particularly posterior capsular rupture (PCR) with or without vitreous loss.Methods Single centre electronic medical record database study of 18065 consecutive first eye cataract operations performed between 2005 and 2014. Survival analysis was performed with Kaplan–Meier curves and a Cox proportional hazard regression analysis to calculate HRs with respect to RD.Results The RD rate at 3months and 7years was 0.067% and 0.30%, respectively, with a median time to RD of 15months (mean: 18months, range: 0–84months). Men had a higher RD risk (HR 2.00; 95% CI 1.03 to 3.88; p=0.03) in the univariate model. Patients <60years and those >80years had an HR of 5.12 (95% CI 2.60 to 10.07; p<0.001) and 0.16 (95% CI 0.38 to 0.69; p=0.01), respectively, compared with patients 60–80years of age. Eyes longer than 25mm had an HR of 3.98 (95% CI 1.93 to 8.20; p<0.001) compared with eyes 23–25mm. PCR occurred in 400 (2.2%) eyes. The HR for RD was 12.83 (95% CI 5.62 to 29.30; p<0.001) for PCR with vitreous loss. There were no RD events in eyes with PCR without vitreous loss.Conclusions The risk for RD after cataract surgery is higher in younger patients and eyes with longer axial length or PCR with vitreous loss during surgery.


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