Smith Michael, Raman S Vasant, Pappas George, Simcock Peter, Ling Roland, Shaw Steve
West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, United Kingdom.
Retina. 2007 Apr-May;27(4):462-7. doi: 10.1097/01.iae.0000243066.19645.de.
To review the results of phacovitrectomy for primary retinal detachment repair in presbyopes.
The outcome and complications of surgery were examined in a retrospective case series of 93 presbyopic patients who underwent phacoemulsification and vitrectomy for primary rhegmatogenous retinal detachment.
Eighty-two patients (88.2%) had reattachment with a single procedure. The final reattachment rate with further procedures was 97.8%. Two patients (2.2%) in whom final reattachment did not occur declined further surgery after the primary repair. All redetachments were due to proliferative vitreoretinopathy. The median Snellen converted logMAR visual acuity improved from 1.00 preoperatively to 0.30 postoperatively (P < 0.001, Wilcoxon test). Postoperative complications included transient intraocular pressure rise (29%), fibrinous uveitis (16.2%), and iris/intraocular lens capture (8.6%). One of the eight patients with iris/intraocular lens capture required surgical reintervention. All cases of fibrinous uveitis and intraocular pressure rise resolved within a few days with medical treatment. Posterior capsular opacification occurred in 23 patients (24.7%).
Combined surgery with phacoemulsification, lens extraction, and vitrectomy offers significant advantages to both patient and surgeon in the management of primary retinal detachment. We believe that it should be considered for presbyopes even in the absence of significant lens opacity. Fibrinous uveitis and intraocular pressure rise may occur in a few patients in the immediate postoperative period but are transient and resolve with medical treatment. Further prospective studies are required, in particular to examine the rate of postoperative proliferative vitreoretinopathy, which may be higher than with vitrectomy alone.
回顾晶状体玻璃体切除术治疗老视患者原发性视网膜脱离修复的结果。
对93例因原发性孔源性视网膜脱离接受超声乳化和玻璃体切除术的老视患者进行回顾性病例系列研究，检查手术结果和并发症。
82例患者（88.2%）一次手术视网膜复位。进一步手术后最终视网膜复位率为97.8%。2例（2.2%）最终未实现视网膜复位的患者在初次修复后拒绝进一步手术。所有视网膜再脱离均因增殖性玻璃体视网膜病变。Snellen转换后的logMAR视力中位数从术前的1.00提高到术后的0.30（P<0.001，Wilcoxon检验）。术后并发症包括短暂性眼压升高（29%）、纤维素性葡萄膜炎（16.2%）和虹膜/人工晶状体夹持（8.6%）。8例虹膜/人工晶状体夹持患者中有1例需要再次手术干预。所有纤维素性葡萄膜炎和眼压升高病例经药物治疗在数天内消退。23例患者（24.7%）发生后囊膜混浊。
超声乳化、晶状体摘除和玻璃体切除术联合手术在原发性视网膜脱离的治疗中对患者和外科医生均具有显著优势。我们认为，即使晶状体无明显混浊老视患者也应考虑采用该方法。少数患者术后短期内可能发生纤维素性葡萄膜炎和眼压升高，但为短暂性，经药物治疗可消退。需要进一步进行前瞻性研究，尤其是要检查术后增殖性玻璃体视网膜病变的发生率，其可能高于单纯玻璃体切除术。
