| BackgroundRetinal detachment with silicone oil tamponade is a common new clinical symptom accompanied by the application of silicone oil after vitrectomy.With the invention of vitrectomy system and the progress of vitreoretinal surgery technology,together with the special properties of silicone oil itself(good transparency,stable physical and chemical properties,not absorbed by tissues,appropriate surface tension,no adverse reactions after surgery),complex ocular trauma,complex retinal detachment and other complex refractory ophthalmopathy are currently caused.The success rate of the operation has been greatly improved.The role and application of silicone oil as vitreous substitute and retinal tamponade are expanding.Although silicone oil has been proven to be a very effective material for the treatment of complex ophthalmopathy.However,the incidence of retinal detachment under silicone oil tamponade is still high,ranging from 21.4%to 77%.For ophthalmologists engaged in clinical work,the diagnosis and management of retinal detachment in silicone oil?filled eyes is still a great challenge.ObjectiveTo analyze the clinical characteristics of retinal detachment treated by vitrectomy combined with silicone oil tamponade and the occurrence of retinal detachment in silicone oil tamponade eyes,and to explore the risk factors of retinal detachment recurrence and the causes of recurrent retinal detachment.MethodsThe clinical data of 412 cases(412 eyes)of complicated retinal detachment and57 cases(57 eyes)of recurrent retinal detachment were retrospectively analyzed from November 2016 to October 2018 in Zhengdong Hospital Ophthalmological Department.The risk factors and related causes of recurrent retinal detachment were analyzed.Statistical methods:SPSS 21.0 software was used to analyze the data,and the qualitative data were described by composition ratio.?~2 test was used among the groups.The relative risk of each factor was expressed by odds ratio and 95%confidence interval(CI)was calculated,with P<0.05 as the statistical difference.The paired t-test was used to compare the visual acuity(logMAR)before and after retinal reattachment,with P<0.05 as the statistical difference.ResultsOf 412 patients(412 eyes)with retinal detachment who underwent vitrectomy combined with silicone oil tamponade for the first time,57(13.83%)had recurrence.The main causes of recurrent retinal detachment during retinal repair were the development of PVR in 37 eyes(64.91%),poor closure of primary holes or formation of new holes in 12 eyes(21.05%)and subretinal effusion in 8 eyes(14.04%).The risk of retinal detachment was higher in patients with primary retinal detachment with PVR(?C),high myopia,inferior hole,macular hole with high myopia,and advanced age(?60 years).The difference was statistically significant(?~2=10.00,P<0.05,OR=2.506;?~2=9.72,P<0.05,OR=2.759;?~2=24.76,P<0.05,OR=5.810;?~2=7.78,P<0.05,OR=2.=7.292;?~2=17.307,P<0.05,OR=3.486);while preoperative differences in eye type,gender,retinal hole size,number of retinal holes had no significant effect on the recurrence of retinal detachment after surgery,the difference was not statistically significant(P>0.05).Retinal reattachment was performed in 46 eyes(80.70%)with improved visual acuity,8 eyes(14.04%)with unchanged visual acuity and 3 eyes(5.26%)with decreased visual acuity.The average visual acuity before and after retinal repair(BVCA,logMAR)was significantly better than that before retinal repair(t=3.725,P<0.05).Conclusion1.The risk of recurrence of retinal detachment after vitrectomy combined with silicone oil injection is higher in patients with retinal detachment combined with PVR(?C),high myopia,inferior hole,macular hole with high myopia and old age(?60years).2.The primary cause of retinal detachment in silicone oil-filled eyes is the progress of PVR,followed by poor closure of primary holes or formation of new holes,and subretinal effusion.3.Retinal repair with silicone oil tamponade for recurrent retinal detachment of silicone oil eye can achieve better therapeutic effect. |
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