Scott I U, Flynn H W, Azen S P, Lai M Y, Schwartz S, Trese M T
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Florida 33136, USA.
Ophthalmology. 1999 Jul;106(7):1399-407; discussion 1407-8. doi: 10.1016/S0161-6420(99)00731-9.
To report anatomic and visual acuity outcomes, as well as complications, after using 1000-centistoke silicone oil as a retinal tamponade for the treatment of complex retinal detachments in a pediatric population.
A prospective, observational, multicenter study.
The study cohort consisted of 205 patients 16 years of age or younger (211 eyes) treated at community and university-based ophthalmology clinics for complex retinal detachments associated with trauma, proliferative vitreoretinopathy (PVR), giant retinal tear (GRT), or retinopathy of prematurity (ROP).
Vitrectomy surgery for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade.
Anatomic outcomes include complete retinal attachment and macular attachment. Visual acuity outcomes include ambulatory vision (> or = 4/200) and preservation of preoperative visual acuity. Complications include rates of secondary intraocular pressure (IOP) elevation (> or = 30 mmHg), hypotony (< or = 5 mmHg), corneal opacification (including band keratopathy, corneal edema, and corneal abrasions), oil emulsification, and cataract. All outcome measures were assessed 6, 12, and 24 months after surgery and at last examination.
At the 6-month examination, the retina was completely attached in 43 (57%) of 76 eyes in the trauma group, 24 (63%) of 38 PVR eyes, 23 (68%) of 34 GRT eyes, and 6 (33%) of 18 ROP eyes. The macula was attached in 60 (79%), 33 (87%), 26 (76%), and 8 (44%) eyes, respectively. Ambulatory vision was achieved in 19 (25%) eyes in the trauma group, 18 (47%) PVR eyes, 19 (56%) GRT eyes, and 4 (22%) ROP eyes. Visual acuity was preserved in 53 (70%), 26 (68%), 28 (82%), and 9 (50%) eyes, respectively. The corresponding rates of complications for traumatic, PVR, GRT, and ROP eyes were: elevated IOP-3 (4%) of 76, 1 (3%) of 38, 1 (3%) of 34, and 0 (0%) of 18; hypotony--9 (12%), 3 (8%), 2 (6%), and 2 (11%); corneal opacity--25 (33%), 8 (21%), 15 (44%), and 5 (28%); emulsification--4 (5%), 1 (3%), 3 (9%), and 1 (6%); and cataract in phakic eyes--1 (33%) of 3, 2 (67%) of 3, 2 (50%) of 4, and 1 (33%) of 3.
Retinal reattachment and preserved visual acuity were achieved in the majority of eyes using vitrectomy and silicone oil retinal tamponade. Complete retinal and macular attachment was achieved less frequently in ROP eyes than in eyes in the other diagnostic groups. Use of 1000-centistoke silicone oil can be considered in the management of pediatric complex retinal detachments associated with multiple etiologies.
报告在儿科人群中使用1000厘沲硅油作为视网膜填塞物治疗复杂性视网膜脱离后的解剖学和视力结果以及并发症情况。
一项前瞻性、观察性、多中心研究。
研究队列包括205例16岁及以下患者（211只眼），这些患者在社区和大学眼科诊所接受治疗，患有与创伤、增生性玻璃体视网膜病变（PVR）、巨大视网膜裂孔（GRT）或早产儿视网膜病变（ROP）相关的复杂性视网膜脱离。
采用玻璃体切除术治疗复杂性视网膜脱离，使用1000厘沲硅油作为视网膜填塞物。
解剖学结果包括视网膜完全复位和黄斑复位。视力结果包括可走动视力（≥4/200）和术前视力的保留情况。并发症包括继发性眼压升高（≥30 mmHg）、低眼压（≤5 mmHg）、角膜混浊（包括带状角膜病变、角膜水肿和角膜擦伤）、油乳化和白内障的发生率。所有观察指标在术后6、12和24个月以及最后一次检查时进行评估。
在6个月检查时，创伤组76只眼中有43只（57%）视网膜完全复位，PVR组38只眼中有24只（63%），GRT组34只眼中有23只（68%），ROP组18只眼中有6只（33%）。黄斑复位的眼数分别为60只（79%）、33只（87%）、26只（76%）和8只（44%）。创伤组19只（25%）眼、PVR组18只（47%）眼、GRT组19只（56%）眼和ROP组4只（22%）眼达到可走动视力。视力保留的眼数分别为53只（70%）、26只（68%）、28只（82%）和9只（50%）。创伤性、PVR、GRT和ROP眼的相应并发症发生率为：眼压升高——76只眼中3只（4%）、38只眼中1只（3%）、34只眼中1只（3%）、18只眼中0只（0%）；低眼压——9只（12%）、3只（8%）、2只（6%）、2只（11%）；角膜混浊——25只（33%）、8只（21%）、15只（44%）、5只（28%）；乳化——4只（5%）、1只（3%）、3只（9%）、1只（6%）；有晶状体眼中白内障——3只眼中1只（33%）、3只眼中2只（67%）、4只眼中2只（50%）、3只眼中1只（33%）。
大多数眼通过玻璃体切除术和硅油视网膜填塞术实现了视网膜复位和视力保留。ROP眼实现视网膜和黄斑完全复位的频率低于其他诊断组的眼。在治疗与多种病因相关的儿科复杂性视网膜脱离时可考虑使用1000厘沲硅油。
