Tabandeh H, Chaudhry N A, Smiddy W E
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Florida 33101, USA.
Retina. 1999;19(4):281-6. doi: 10.1097/00006982-199907000-00002.
To study the frequency, features, and outcomes of retinal detachment (RD) occurring after macular hole surgery.
Retrospective review of all cases of macular hole surgery. Cases with postoperative RD were identified for study. Outcome measures included baseline demographic and ocular characteristics, RD features, surgical procedure, macular hole status, and final visual and anatomic outcomes.
Retinal detachment occurred in 8 (1.8%) of 438 eyes undergoing macular hole surgery. The rate of RD was 3.5% early in the course of the surgeon's experience (first 200 cases) and 0.4% later in the surgeon's experience (after 200 cases) (P = 0.026). Two of the eight eyes with RD had undergone previous macular hole surgery. All six primary cases occurred after repair of stage 3 macular holes, which had involved peeling of the posterior cortical face. The RD involved the inferior quadrants in seven eyes and the macula in two eyes. The pathogenic retinal break was in the equatorial region in four eyes, was anterior to the equator in two eyes, and remained undetermined in two eyes. The retina was attached and the macular hole was closed in all cases at the final follow-up examination (mean 30 months). The macular hole reopened 2 years following successful reattachment of the RD in one eye. Final visual acuity was > or =20/60 in four eyes and <20/200 in one eye.
Retinal detachment after macular hole surgery is uncommon, and may be related to posterior cortical vitreous stripping. Early detection of RD minimizes adverse visual and anatomic outcomes.
研究黄斑裂孔手术后发生视网膜脱离（RD）的频率、特征及预后。
对所有黄斑裂孔手术病例进行回顾性分析。确定术后发生RD的病例进行研究。观察指标包括基线人口统计学和眼部特征、RD特征、手术方式、黄斑裂孔状态以及最终视力和解剖学预后。
438只接受黄斑裂孔手术的眼中，有8只（1.8%）发生了视网膜脱离。在手术医生经验早期（前200例），RD发生率为3.5%，后期（200例之后）为0.4%（P = 0.026）。8只发生RD的眼中有2只曾接受过黄斑裂孔手术。所有6例原发性病例均发生在3期黄斑裂孔修复术后，术中进行了后皮质玻璃体剥除。RD累及7只眼的下象限和2只眼的黄斑区。4只眼的致病视网膜裂孔位于赤道区，2只眼在赤道前，2只眼未明确。在最后一次随访检查时（平均30个月），所有病例视网膜均复位，黄斑裂孔均闭合。1只眼在RD成功复位2年后黄斑裂孔重新开放。最终视力4只眼≥20/60，1只眼<20/200。
黄斑裂孔手术后视网膜脱离并不常见，可能与后皮质玻璃体剥除有关。早期发现RD可将不良视力和解剖学预后降至最低。
