摘要
目的:探讨纯全氟丙烷(C3F8)填充联合玻璃体切割术(PPV)治疗视网膜脱离(RD)的疗效。方法:选择2022年3月至2022年11月于北京大学第三医院眼科行23G PPV联合C3F8填充治疗RD患者97例(97只眼)作为研究对象。其中，男性45例(45只眼)，女性52例(52只眼)；年龄41~71岁，平均(56.5±15.2)岁。依据术中气体填充方式将患者分为纯气组33例(33只眼)和混合气组64例(64只眼)。全部患者实施气体填充联合PPV治疗，纯气组术中给予适量100%C3F8，混合气组给予非膨胀浓度C3F8与无菌空气的混合气体。检查并记录患者的最佳矫正视力(BCVA)、眼压、眼轴长度、术后视网膜末次复位率及术后眼部炎症情况。BCVA、眼压及眼轴长度符合正态分布，以±s表示，组间比较采用独立样本t检验，组内手术前后比较采用配对样本t检验。两组眼压范围和术后眼部炎症情况采用例数和百分比描述，组间比较采用秩和检验；术后视网膜末次复位率采用Fisher精确检验。多时间点重复测量数据采用重复测量方差分析。结果:纯气组患者术中配置眼内气体用时、注入气体用时及C3F8用量分别为(2.48±0.51)s、(5.09±1.21)s及(0.64±0.20)ml；混合气组分别为(16.62±6.20)s、(180.34±34.30)s及(4.69±2.59)ml，两组差异均有统计学意义(t＝－18.207，－40.836，－12.41；P<0.05)。纯气组和混合气组患者术后6个月时的视网膜末次复位率分别为97.0%和98.4%，其差异无统计学意义(P>0.05)。经重复测量方差分析，两组患者术前、术后即刻、术后1 d及术后1个月时的眼压组别效应无统计学意义(F组别＝0.032，P>0.05)；时间效应有统计学意义(F时间＝23.215，P<0.05)；交互效应无统计学意义(F交互＝1.735，P>0.05)。纯气组术后最高眼压≤21 mmHg(1 mmHg＝0.133 kPa)、>21 mmHg且<30 mmHg及≥30 mmHg者分别为8例(8只眼)、14例(14只眼)及11例(11只眼)，分别占24.2%、42.4%及33.3%；混合气组分别为18例(18只眼)、32例(32只眼)及14例(14只眼)，分别占28.1%、50.0%及21.9%，两组术后最高眼压分布差异无统计学意义(Z＝－0.979，P>0.05)。术后末次随访BCVA纯气组优于混合气组，其差异有统计学意义(t＝－2.497，P<0.05)。两组患者术后眼部炎症等级分布的差异无统计学意义(Z＝－1.430，P>0.05)。结论:相较于混合气组，纯气组RD治疗效果更好，无术后并发症劣势，同时术后BCVA更好，术中配置眼内气体用时、注入气体用时及C3F8用量更少。
Abstract
Objective:The aim of this study is to evaluate the efficacy of pure perfluoropropane (C3F8) tamponade combined with vitrectomy (PPV) in the treatment of retinal detachment (RD).Methods:Ninety-seven patients (97 eyes) with RD who underwent 23G PPV combined with C3F8 tamponade at the Department of Ophthalmology of Peking University Third Hospital from March to November 2022 were selected as the research subjects. Among them, there were 45 males (45 eyes) and 52 females (52 eyes) ranged from 41 to 71 years with an average age of (56.5±15.2) years. According to the gas tamponade type, the patients were divided into pure gas group with 33 cases (33 eyes) and mixed gas group with 64 cases (64 eyes). All patients were treated by gas tamponade combined with PPV, and the pure gas group was given an appropriate amount of 100% C3F8, and the mixed gas group was given a mixture of non-expanding concentration of C3F8 and sterile air. The best corrected visual acuity (BCVA), intraocular pressure, axial length, the last retinal reattachment rate after operation and postoperative ocular inflammation were determined and recorded. The BCVA, intraocular pressure, axial length were in accordance with the normal distribution, described by ±s, and compared by the independent sample t test for inter-group and paired sample t test for intra-group before and after operation. The range of intraocular pressure and postoperative ocular inflammation in the two groups were described by the eyes number and percentage and compared by rank sum test for inter-group. Fisher′s exact test was used for the last retinal reattachment rate after operation. Repeated measurement data at multiple time points were analyzed by repeated measures ANOVA.Results:In the pure gas group, the time for intraocular gas preparation, gas injection and C3F8 consumption were (2.48±0.51)s, (5.09±1.21)s and (0.64±0.20)ml, respectively. In the mixed gas group, those were (16.62±6.20)s, (180.34±34.30)s and (4.69±2.59)ml, respectively, and the differences were statistically significant (t= -18.207, -40.836, -12.41; P<0.05). The last retinal reattachment rate was 97.0% in pure gas group and 98.4% in mixed gas group after operation for 6 months, and the difference was not statistically significant (P>0.05). There was no significant difference in the group effect of intraocular pressure between the two groups before surgery, immediately after surgery, after surgery for 1 day and 1 month (Fgroup=0.032, P>0.05). The time effect was statistically significant (Ftime=23.215, P<0.05). The interaction effect was not statistically significant (Finteraction=1.735, P>0.05). In the pure gas group, there were 8 cases (8 eyes) with the highest intraocular pressure < 21 mmHg(1 mmHg=0.133 kPa), 14 cases (14 eyes) with the highest intraocular pressure from 21 mmHg to 30 mmHg, and 11 cases (11 eyes) with the highest intraocular pressure ≥30 mmHg, accounting for 24.2%, 42.4% and 33.3%, respectively. In the mixed gas group, there were 18 cases (18 eyes) with the highest intraocular pressure < 21 mmHg, 32 cases (32 eyes) with the highest intraocular pressure from 21 mmHg to 30 mmHg, and 14 cases (14 eyes) with the highest intraocular pressure ≥30 mmHg, accounting for 28.1%, 50.0% and 21.9%, respectively. There was no significant difference in the distribution of the highest intraocular pressure between the two groups (Z= -0.979, P>0.05). The BCVA of the pure gas group was better than that of the mixed gas group at the last follow-up, and the difference was statistically significant (t= -2.497, P<0.05). There was no significant difference in postoperative ocular inflammation between the pure gas group and the mixed gas group (Z= -1.430, P> 0.05).Conclusions:Compared with the mixed gas tamponade group, the pure gas group has a better RD efficacy, no postoperative complications, and shows better postoperative BCVA. It can shorten the time of intraocular gas preparation and injection and reduce the dosage of C3F8.
基金项目
西藏自治区自然科学基金组团式援藏医学项目(XZ2022ZR-ZY5)
万方数据