复杂视网膜脱离手术后不同黏度硅油取出的比较
Comparison of silicon oil removal with various viscosities after complex retinal detachment surgery.
作者信息
Soheilian Masoud, Mazareei Mohammad, Mohammadpour Mehrdad, Rahmani Bahram
机构信息
Ophthalmology Department and Ophthalmic Research Center Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, 16666, Iran.
出版信息
BMC Ophthalmol. 2006 May 31;6:21. doi: 10.1186/1471-2415-6-21.
BACKGROUND
Despite the progress in vitreoretinal surgery and the importance of silicone oil as an adjunct for the treatment of complex forms of retinal detachment, controversy still surrounds the issue of selecting the proper oil viscosity for clinical use. Herein, we evaluate the outcomes of retinal detachment (RD) surgery after removing silicone oils of different viscosities.
METHODS
In this retrospective cohort study, eighty-two eyes with surgically re-attached retinas, of which 53 were filled with 5000 cs silicone oil and 29 with 1000 cs silicone oil were enrolled. We evaluated the outcomes and complications following silicone oil removal. Final anatomic success (stable re-attachment), final visual acuity (VA) and intraocular pressure (IOP)were recorded and analysed.
RESULTS
Of 82 eyes, 41 had proliferative vitreoretinopathy (PVR), 24 were associated with intraocular foreign bodies, 10 had endophthalmitis and 7 had proliferative diabetic retinopathy with tractional retinal detachment. Prior to silicone oil removal, the retina was attached in all eyes, 29% had VA > or = 6/120 and 52% had IOP > or = 21 mmHg. After silicone oil removal, the retina remained attached in 59(72%) of the eyes, 34% had VA > or = 6/120 and 9% had IOP > or = 21 mmHg. Comparing 1000 cs and 5000 cs silicone oil filled eyes, redetachment occurred more frequently in the latter group especially in cases with associated PVR. Final VA worse than 6/120 was associated with initial VA < 6/120 (OR = 32.2 95%CI 7.4-140.2) and use of 5000 cs silicone oil (OR = 7.9 95%CI 1.9-32.2). No factor was significantly associated with final IOP > or = 21 mmHg.
CONCLUSION
In complicated retinal detachment surgery, use of 5000 cs silicone oil may be associated with a poorer anatomic and visual outcome compared with 1000 cs silicone oil. However there was no difference between the two viscosities in IOP elevation. A randomized controlled study is necessary to further evaluate such a possibility.
背景
尽管玻璃体视网膜手术取得了进展，且硅油作为治疗复杂视网膜脱离的辅助材料具有重要意义，但临床使用中选择合适的硅油粘度问题仍存在争议。在此，我们评估了去除不同粘度硅油后视网膜脱离（RD）手术的效果。
方法
在这项回顾性队列研究中，纳入了82只视网膜手术复位的眼睛，其中53只填充了5000厘沲硅油，29只填充了1000厘沲硅油。我们评估了硅油取出后的效果和并发症。记录并分析最终的解剖学成功（视网膜稳定复位）、最终视力（VA）和眼压（IOP）。
结果
82只眼中，41只患有增殖性玻璃体视网膜病变（PVR），24只伴有眼内异物，10只患有眼内炎，7只患有增殖性糖尿病视网膜病变伴牵引性视网膜脱离。在取出硅油之前，所有眼睛的视网膜均已复位，29%的患者视力VA≥6/120，52%的患者眼压IOP≥21 mmHg。取出硅油后，59只（72%）眼睛的视网膜仍保持复位，34%的患者视力VA≥6/120，9%的患者眼压IOP≥21 mmHg。比较填充1000厘沲和5000厘沲硅油的眼睛，后者组视网膜再脱离的发生率更高，尤其是在伴有PVR的病例中。最终视力差于6/120与初始视力VA<6/120（比值比OR = 32.2，95%置信区间CI 7.4 - 140.2）以及使用5000厘沲硅油（比值比OR = 7.9，95%置信区间CI 1.9 - 32.2）有关。没有因素与最终眼压IOP≥21 mmHg显著相关。
结论
在复杂视网膜脱离手术中，与1000厘沲硅油相比，使用5000厘沲硅油可能导致解剖学和视觉效果较差。然而，两种粘度在眼压升高方面没有差异。需要进行随机对照研究以进一步评估这种可能性。
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