【作者】 刘博；

【导师】 李旭；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2025， 硕士

【摘要】 目的:本课题旨在探讨玻璃体切除联合硅油填充治疗孔源性视网膜脱离术后,缩短硅油填充时间的视觉功能恢复、结构改善及安全性分析。方法:回顾性分析2023年6月至2024年10月期间就诊于吉林大学第二医院因孔源性视网膜脱离行25G玻璃体切除术联合硅油填充的194例患者。根据取油时间将患者分为两组。短期组(取油时间≤12周)100例,常规组(取油时间>12周)94例。术后随访至少1个月,观察记录视力变化及并发症发生情况,光学相干断层扫描(Optical Coherence Tomography,OCT)测量患者硅油填充术后不同时间点(注油术后1周、取油前1周、取油后1个月)的中央黄斑厚度(Central Macular Thickness,CMT)、视网膜神经纤维层(Retinal Nerve Fiber Layer,RNFL)厚度。结果:两组术前及术后视力组间比较差异均无统计学意义(P>0.05);组间比较注油术后1周的CMT、RNFL厚度比较差异无统计学意义(P>0.05),但两组取油前1周、取油后1个月两个时间点的CMT、RNFL厚度比较,差异有统计学意义(P<0.05);组内比较取油前1周CMT、RNFL厚度与硅油填充术后1周比较明显变薄(P<0.05);而取油后1个月CMT、RNFL厚度与取油前1周比较差异无统计学意义(P>0.05)。两组术后发生视网膜脱离复发、黄斑前膜、黄斑囊样水肿及视网膜下液的差异无统计学意义(P>0.05)。结论:1.对于孔源性视网膜脱离行玻璃体切割联合硅油填充术的患者,短期组(≤12周)与常规组(>12周)相比患者视力无明显差异,但短期组CMT和RNFL厚度变薄风险小于常规组,对视网膜结构损伤更小。2.对于孔源性视网膜脱离行玻璃体切割联合硅油填充术的患者,短期组(≤12周)与常规组(>12周)比较,视网膜脱离复发的机率没有升高。更多还原

【Abstract】 Objective:The purpose of this study is to explore the visual function recovery,structural improvement and safety analysis of shortening the filling time of silicone oil in the treatment of rhegmatogenous retinal detachment after vitrectomy combined with silicone oil filling.Methods:A total of 194 patients with rhegmatogenous retinal detachment underwent 25G vitrectomy combined with silicone oil filling admitted to our hospital from June 2023 to October 2024 were analyzed retrospectively.Patients were divided into two groups according to the time of oil extraction.There were 100 cases in the short-term group(the time of oil removal ≤12 weeks)and 94 cases in the conventional group(the time of oil removal>12 weeks).The changes of visual acuity and complications were observed and recorded at least one month after operation.The central macular thickness(Central Macular Thickness,CMT)and retinal nerve fiber layer(Retinal Nerve Fiber Layer,RNFL)thickness were measured by optical coherence tomography(Optical Coherence Tomography OCT)at different time points after silicone oil filling(1 week after oil injection,1 week before oil extraction,1 month after oil extraction).Results:There were no statistically significant differences in preoperative and postoperative visual acuity between the two groups(P>0.05).Intergroup comparisons of central macular thickness(CMT)and retinal nerve fiber layer(RNFL)thickness at 1 week after silicone oil tamponade also showed no significant differences(P>0.05).However,statistically significant differences in CMT and RNFL thickness were observed between the two groups at 1 week before oil removal and 1 month after oil removal(P<0.05).Intragroup comparisons revealed that CMT and RNFL thickness at 1 week before oil removal were significantly thinner compared to 1 week after silicone oil tamponade(P<0.05),while no significant difference were found between CMT and RNFL thickness at 1 month after oil removal and 1 week before oil removal(P>0.05).No statistically significant differences were observed between the two groups in the incidence of postoperative retinal detachment recurrence,epiretinal membrane,cystoid macular edema,or subretinal fluid(P>0.05).Conclusions:1.For patients with rhegmatogenous retinal detachment undergoing vitrectomy combined with silicone oil tamponade,the short-term oil removal group(≤ 12 weeks)showed no significant difference in visual acuity compared to the conventional group(>12 weeks).However,the short-term group had a lower risk of CMT and RNFL thinning,indicating less structural damage to the retina.2.For patients with rhegmatogenous retinal detachment treated with vitrectomy and silicone oil tamponade,the short-term oil removal group(≤12 weeks)did not exhibit an increased risk of retinal detachment recurrence compared to the conventional group(>12 weeks).更多还原