Martínez-Castillo Vicente, Boixadera Anna, García-Arumí José
Vall d'Hebrón Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain.
Arch Ophthalmol. 2009 Oct;127(10):1297-304. doi: 10.1001/archophthalmol.2009.254.
To report on pars plana vitrectomy with diffuse illumination, wide-angle viewing, and meticulous vitreous dissection for identifying and managing retinal breaks when no breaks were detected before surgery for primary rhegmatogenous retinal detachment.
Prospective clinical study of 61 of 800 consecutive eyes (7.6%) (61 of 782 patients) seen at a university hospital during the 48-month study for primary rhegmatogenous retinal detachment in whom no break could be identified preoperatively despite thorough examinations. All of the patients underwent pars plana vitrectomy alone with meticulous peripheral vitreous dissection assisted by diffuse illumination, a wide-angle viewing system, perfluorocarbon liquid, triamcinolone acetonide suspension, and balanced salt solution to identify and manage primary retinal breaks.
Retinal breaks were found intraoperatively in 60 eyes (98%). In 51 of 61 eyes (84%), balanced salt solution was left in the vitreous cavity. Best-corrected visual acuity was 20/40 or better in 25 of 61 study eyes (41%). Primary retinal reattachment was attained in 60 study eyes (98%). Final reattachment was achieved in all 61 eyes (100%).
Pars plana vitrectomy alone with diffuse illumination and extensive vitreous dissection led to identification and management of retinal breaks undetectable before surgery, achieving a high primary reattachment rate.
报告在原发性孔源性视网膜脱离手术前未检测到裂孔时，采用弥漫性照明、广角观察和细致的玻璃体切割术来识别和处理视网膜裂孔。
对一所大学医院在为期48个月的原发性孔源性视网膜脱离研究中连续观察的800只眼中的61只眼（7.6%）（782例患者中的61例）进行前瞻性临床研究，这些患者术前尽管经过全面检查仍未发现裂孔。所有患者均单独接受了玻璃体切除术，在弥漫性照明、广角观察系统、全氟碳液、曲安奈德悬浮液和平衡盐溶液辅助下进行细致的周边玻璃体切割，以识别和处理原发性视网膜裂孔。
术中在60只眼中发现视网膜裂孔（98%）。61只眼中有51只眼（84%）的玻璃体腔内留有平衡盐溶液。61只研究眼中有25只眼（41%）的最佳矫正视力达到20/40或更好。60只研究眼中实现了原发性视网膜复位（98%）。所有61只眼最终均实现了视网膜复位（100%）。
单独采用弥漫性照明和平坦部玻璃体切除术及广泛的玻璃体切割术可识别和处理术前未检测到的视网膜裂孔，实现较高的原发性视网膜复位率。
