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巩膜扣带术后原发性慢性孔源性视网膜脱离术后视功能的预测因素

Predictive factors for postoperative visual function of primary chronic rhegmatogenous retinal detachment after scleral buckling.

作者信息

Fang Wei, Li Jiu-Ke, Jin Xiao-Hong, Dai Yuan-Min, Li Yu-Min

机构信息

Department of Ophthalmology, SIR RUN RUN SHAW Hospital, SIR RUN RUN SHAW Institute of Clinical Medicine of Zhejiang University, Hangzhou 310016, Zhejiang Province, China.

出版信息

Int J Ophthalmol. 2016 Jul 18;9(7):994-8. doi: 10.18240/ijo.2016.07.10. eCollection 2016.

Abstract

AIM

To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB).

METHODS

Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon two-sample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement.

RESULTS

Baseline BCVA was 0.8313±0.6911 logMAR and final BCVA was 0.4761±0.4956 logMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r=0.3850, P=0.0053), less detached area (r=0.5489, P<0.0001), fovea (r=0.4605, P=0.0007), no PVR (r=0.3138, P=0.0250), better baseline BCVA (r=0.7291, P<0.0001), shorter operative duration (r=0.3233, P=0.0207) and longer follow up (r=-0.3358, P=0.0160) were related with better final BCVA, while independent predictive factors were better baseline BCVA [partial R-square (PR(2))=0.5316, P<0.0001], shorter symptoms duration (PR(2)=0.0609, P=0.0101), longer follow up duration (PR(2)=0.0278, P=0.0477) and shorter operative duration (PR(2)=0.0338, P=0.0350). Patients with vision improvement took up 49.02% (25/51). Univariate and multivariate analyses both revealed predictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P=0.0041] and longer follow up duration (OR=1.144, P=0.0067).

CONCLUSION

Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.

摘要

目的

评估巩膜扣带术(SB)治疗原发性慢性孔源性视网膜脱离(RRD)术后视功能的预测因素。

方法

本前瞻性干预性临床病例研究共纳入48例(51只眼)原发性慢性RRD患者,这些患者于2008年6月至2014年12月期间仅接受了SB手术。测量了患者的年龄、性别、症状持续时间、脱离范围、视网膜裂孔位置、大小、类型、黄斑是否累及、增殖性玻璃体视网膜病变(PVR)、玻璃体后脱离(PVD)、基线最佳矫正视力(BCVA)、手术时长、随访时长及最终BCVA。采用Pearson相关分析、Spearman相关分析和多元线性逐步回归来确定最终视力较好的预测因素。采用Student's t检验、Wilcoxon两样本检验、卡方检验和逻辑逐步回归来确定视力改善较好的预测因素。

结果

基线BCVA为0.8313±0.6911 logMAR,最终BCVA为0.4761±0.4956 logMAR。一期手术成功率为92.16%(47/51)。相关性分析显示,症状持续时间较短(r=0.3850,P=0.0053)、脱离面积较小(r=0.5489,P<0.0001)、黄斑未累及(r=0.4605,P=0.0007)、无PVR(r=0.3138,P=0.0250)、基线BCVA较好(r=0.7291,P<0.0001)、手术时长较短(r=0.3233,P=0.0207)及随访时间较长(r=-0.3358,P=0.0160)与最终BCVA较好相关,而独立预测因素为基线BCVA较好[偏R平方(PR(2))=0.5316,P<0.0001]、症状持续时间较短(PR(2)=0.0609,P=0.0101)、随访时间较长(PR(2)=0.0278,P=0.0477)及手术时长较短(PR(2)=0.0338,P=0.0350)。视力改善的患者占49.02%(25/51)。单因素和多因素分析均显示,视力改善较好的预测因素为基线视力较好[比值比(OR)=50.369,P=0.0041]及随访时间较长(OR=1.144,P=0.0067)。

结论

SB治疗原发性慢性RRD后视力预后较好的独立预测因素为基线BCVA较好、症状持续时间较短、手术时长较短及随访时间较长,而术后视力改善较好的独立预测因素为基线视力较好及随访时间较长。

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