Miller Daniel M, Riemann Christopher D, Foster Robert E, Petersen Michael R
Cincinnati Eye Institute, Cincinnati, Ohio, USA.
Retina. 2008 Jul-Aug;28(7):931-6. doi: 10.1097/IAE.0b013e31816b313a.
To evaluate 25-gauge pars plana vitrectomy (PPV) for primary repair of rhegmatogenous retinal detachment (RRD).
This retrospective, consecutive case series included 42 eyes of 41 patients who underwent primary repair of RRD utilizing transconjunctival 25-gauge PPV without scleral buckling at the Cincinnati Eye Institute from July 2004 through January 2007.
The medical records were retrospectively reviewed, and the corresponding demographic data, preoperative ophthalmic diagnoses, surgical management, and postoperative course and treatment were recorded. Main outcome measures included single surgery anatomical success, preoperative and postoperative visual acuity, and complications.
Most patients had pseudophakic RRD (36 [85.7%] of 42 eyes). The crystalline lens was present in the remaining 6 eyes (14.3%). Of 42 eyes, 28 (66.7%) had macula-on RRD, while 14 (33.3%) had macula-off RRD. Four surgeons contributed to this study, and 25-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and gas tamponade were used in each case. The single surgery anatomical success rate was 92.9% (39 of 42 eyes). For eyes with macula-on RRD, best-corrected visual acuity was 20/50 (0.43 logMAR [logarithm of the minimum angle of resolution]) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.24). For eyes with macula-off RRD, best-corrected visual acuity was 5/200 (1.56 logMAR) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.001). Three eyes required additional surgery for final reattachment. Final reattachment was achieved in 100% of patients (mean follow-up, 8 months).
Twenty-five-gauge PPV with laser retinopexy and gas tamponade is effective for primary repair of RRD. The single operation anatomical success rate is comparable with rates reported for primary vitrectomy with 20-gauge instrumentation, scleral buckling, and combined vitrectomy/scleral buckling.
评估25G经睫状体平坦部玻璃体切除术（PPV）用于原发性孔源性视网膜脱离（RRD）的修复效果。
本回顾性连续病例系列研究纳入了41例患者的42只眼，这些患者于2004年7月至2007年1月在辛辛那提眼科学院接受了采用经结膜25G PPV且未行巩膜扣带术的RRD原发性修复手术。
对病历进行回顾性分析，并记录相应的人口统计学数据、术前眼科诊断、手术治疗及术后病程和治疗情况。主要观察指标包括单次手术的解剖学成功率、术前及术后视力以及并发症。
大多数患者为人工晶状体眼RRD（42只眼中的36只眼[85.7%]）。其余6只眼（14.3%）存在晶状体。42只眼中，28只眼（66.7%）为黄斑在位RRD, 14只眼（33.3%）为黄斑脱离RRD。4名外科医生参与了本研究，每例手术均使用了25G PPV器械、广角观察系统、眼内激光光凝及气体填充。单次手术的解剖学成功率为92.9%（42只眼中的39只眼）。对于黄斑在位RRD的眼，术前最佳矫正视力为20/50（0.43对数最小分辨角[logMAR]），术后为20/30（0.23 logMAR）（P = 0.24）。对于黄斑脱离RRD的眼，术前最佳矫正视力为5/200（1.56 logMAR），术后为20/30（0.23 logMAR）（P = 0.001）。3只眼需要额外手术以实现最终复位。100%的患者实现了最终复位（平均随访8个月）。
25G PPV联合激光视网膜光凝及气体填充用于RRD的原发性修复有效。单次手术的解剖学成功率与报道的采用20G器械的原发性玻璃体切除术、巩膜扣带术以及联合玻璃体切除术/巩膜扣带术的成功率相当。
