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目的研究较复杂的孔源性视网膜脱离患者玻璃体手术或巩膜外手术后的黄斑改变,进一步探讨视网膜脱离术后视功能的恢复。方法回顾性分析孔源性视网膜脱离患者146例152眼手术后的黄斑改变,所有患者术前视力均≥0.1,PVR分级B级,裂孔多、分布广或马蹄形裂孔边缘玻璃体牵引明显的,初次发生的伴黄斑脱离的RRD,随访至少3个月。152眼中行巩膜外手术90眼为A组,行玻璃体手术62眼为B组。结果A、B二组术后视力均显著提高(P<0.01),组间无显著性差异(P>0.05)。黄斑形态学改变中,A组表面膜发生率20.0%,较B组8.0%有显著差异(P<0.05),色素紊乱、水肿、渗出、视网膜下膜发生率组间均无显著性差异(P>0.054)。视觉不适中B组视物变形、眼前闪光、眼球疼痛三个指标明显低于A组(P<0.05),小视、色视、复视三个指标稍低于A组(P>0.05)。结论玻璃体手术对黄斑部的影响较小,视觉不适明显改善,对术后视功能的恢复更有利,但易并发白内障。
Objective To study the macular changes after vitreous surgery or extra-scleral surgery in patients with more complicated rhegmatogenous retinal detachment and to investigate the recovery of visual function after retinal detachment surgery. Methods A retrospective analysis of 146 cases of rhegmatogenous retinal detachment in 146 eyes after macular changes, all patients with preoperative visual acuity were ≥ 0.1, PVR grading B, multiple or extensive holes or horseshoe-shaped hippocampal edge of the vitreous traction obvious, the first occurrence Of the macular detachment RRD, followed up for at least 3 months. Of the 152 eyes, 90 eyes underwent scleral surgery for group A, while 62 eyes underwent vitrectomy for group B. Results The postoperative visual acuity of groups A and B were significantly increased (P <0.01), but there was no significant difference between groups (P> 0.05). In macular morphology, the incidence of surface membrane in group A was 20.0%, which was significantly different from 8.0% in group B (P <0.05), and there was no significant difference between the group of macular degeneration, edema, exudation and the incidence of subretinal P> 0.054). Visual discomfort in group B visual distortion, flash in front of eyeball pain were significantly lower than the three indicators A group (P <0.05), small visual acuity, color vision, diplopia three indicators slightly lower than the A group (P> 0.05). Conclusion The vitreous surgery had less effect on the macula and the visual discomfort was obviously improved. It is more beneficial to the restoration of visual function after operation, but it is easy to complicated cataract.