摘要：
Objective To observe the fundus lesions in the unilateral rhegmatogenous retinal detachment (RRD) eyes and contralateral eyes in non-traumatic emmetropia patients,and explore the risks of lateral eyes.Methods This is a retrospective case analysis.A total of 426 patients of unilateral RRD diagnosed by clinical examination were enrolled in this study.There were 273 males and 74 females.The average age of onset was 54.7 years.81.46％ of them (347 patients) were 51-70 years old.The average detachment time was 2.12 months.They were divided into two groups,equal or lesser than 50 years old group and more than 50 years old group.A total of 100 patients (200 eyes) with ocular surface disorders were randomly selected as control.The lattice-like degeneration,cystic degeneration and dry retinal holes were treated with prophylactic laser photocoagulation.Follow-up period was 6 to 24 months.The age,gender,proliferative vitreous retinopathy (PVR) grading,best corrected visual acuity (BCVA),distribution and quantity of retinal holes,and posterior vitreous detachment (PVD) were retrospectively analyzed.The incidence of PVD among different age groups was compared with Chi square.Results Among 426 RRD eyes,there were 239 eyes (56.10％) with PVD.Among them,there were 30 eyes with age equal or lesser than 50 years old (12.55％) and 209 eyes with age more than 50 years old (84.75％).There were 187 eyes (43.90％) without PVD,which including 38 eyes with age equal or lesser than 50 years old (20.32％) and 149 eyes with age more than 50 years old (79.68％).The incidence of PVD among different age groups was statistically significant (x2=4.72,P＜ 0.05).There were 10,254,40 and 5 eyes in class A,B,C and D of PVR,respectively;117 eyes without PVR.The retinal hole was located in superior temporal,inferior temporal,superior nasal,inferior nasal and macular in 305,91,22,4 and 4 eyes,respectively.The number of holes was 1,2,and more than 3 in 297,89 and 40 eyes,respectively.The retinal detachment range of 1,2,3 quadrants and total dissociation were 92,230,71,33 eyes,respectively.The fundus lesion was found in 47 eyes (11.03％) in the lateral eyes.There were 20 RRD eyes in class B of PVR,and 27 RRD eyes in class C of PVR.Retinal degenerated area was found.Among them,the degeneration of 41 eyes was located in the temporal retina,45 eyes involved in a quadrant.There were 16 eyes with peripheral retinal dry holes;the holes diameter was less than 1,1-2,greater than 2 optic-discs in 6,11 and 5 retinal holes.At the end of the follow-up,there were 47 eyes with almost normal visual field,16 eyes with decreased visual acuity,noeyes with retinal detachment.In the control group,4 patients (5 eyes,2.50％) had fundus lesions.Conclusion The unilateral RRD in non-traumatic emmetropia mostly occurs in elderly patients;11.03％ of patients had fundus lesions in the contralateral eyes,higher than the general population.%目的 观察非外伤性正视眼单侧孔源性视网膜脱离(RRD)及对侧眼眼底改变,初步探讨正视眼RRD患者对侧眼的发病风险.方法 回顾性病例分析.临床检查确诊的非外伤性正视眼单侧RRD患者426例纳入研究.其中,男性273例,女性74例;男∶女≈3.69∶1.患眼、对侧眼各为426只眼.平均发病年龄54.7岁.其中,51～70岁者347例,占81.46％.平均脱离时间2.12个月.将年龄分为≤50、＞50岁.随机选择正视眼眼表疾病100例200只眼作为对照.对侧眼眼底出现格子样变性、囊样变性、干性裂孔给予预防性激光光凝治疗.随访时间6～24个月.回顾分析患者年龄、性别、增生性玻璃体视网膜病变(PVR)分级、最佳矫正视力(BCVA)、裂孔分布及数量、有无玻璃体后脱离(PVD)等.不同年龄者之间PVD发生率比较行x2检验.结果 426只RRD眼中,有PVD者239只眼(56.10％),其中年龄≤50、＞50岁者分别为30(12.55％)、209 (87.4％)只眼;无PVD者187只眼(43.90％),其中年龄≤50、＞50岁者分别为38 (20.32％)、149 (79.68)只眼.不同年龄者之间PVD发生率比较,差异有统计学意义(x2=4.72,P＜0.05).PVRA、B、C、D级分别为10、254、40、5只眼;无PVR 117只眼.视网膜裂孔位于颞上、颞下、鼻上、鼻下象限和黄斑区分别为305、91、22、4、4只眼;裂孔数量1、2、≥3个分别为297、89、40只眼.视网膜脱离范围1、2、3个象限和全脱离分别为92、230、71、33只眼.426只对侧眼中,发现眼底病变47只眼(11.03％).对应RRD眼PVR B、C级分别为20、27只眼.眼底视网膜均有变性区,其中变性区位于颞侧41只眼;累及1个象限有45只眼.伴有周边干性裂孔16只眼;裂孔≤1、1～2、≥2 DD分别为6、11、5个.末次随访时,47只眼视野检查均无明显异常,不同程度视觉敏感度下降16只眼;未出现视网膜脱离或明显视力下降.对照者100例200只眼中,发现眼底病变4例5只眼,占2.50％.结论 非外伤性正视眼单侧RRD多为老年患者;11.03％的对侧眼存在眼底病变,高于一般人群.
