Bialasiewicz A A, Shenoy R, Al Saeidi R M, Al-Belushi H M
Dept. of Ophthalmology and School of Ophthalmic Technicians, Sultan Qaboos University College of Medicine and Health Sciences, Muscat, Oman.
Ophthalmologe. 2011 Feb;108(2):156-63. doi: 10.1007/s00347-010-2213-9.
Vitreoretinal diseases in Middle Eastern countries currently rank in importance behind cataract, trachoma and glaucoma. This study reports on the most frequent causes of vitreoretinal diseases and the results of vitreoretinal surgery in Oman in order to gain insights into requirements in training and equipment.
Demographic data and biomicroscopic examinations were performed over a 5-year period. Pars plana vitrectomies were carried out with the Accurus 800CS (Alcon) and EyeLite® 532 nm Laser (Alcon), endotamponade with silicone oil 5600 cs (adatomed) or C₃F₈ Ispan (Alcon), oval silicone sponge scleral buckles 5.5 x 7.5 mm type 507 (Geuder®) in adults and oval silicone sponge scleral buckles 3.0 × 5.0 mm type 506 (Geuder®) in children (up to 12 years) were sutured with Mersilene parallel to the limbus. Patients were followed after 4 weeks and 1 year. Evaluation of data was done by descriptive statistics (Fisher exact and χ²-tests).
From 2002 to 2006, 2,910 vitreoretinal surgeries were performed on 784 adult and 101 pediatric eyes. Main indications were proliferative diabetic vitreoretinopathy (PDVR) (229/784 eyes=29%), followed by trauma (166/784=21%), and PVR retinal detachment (112/784=14.3%) in adults and in children the main indication was trauma (73/101 eyes=73%). The postoperative vision in adults with trauma, PVR retinal detachment, epiretinal gliosis and IOL extraction was significantly different and better (p=0.003, p=0.044, p=0.029, p=0.001, respectively) and the postoperative vision in PDVR with uncontrolled diabetes mellitus II significantly different and worse (p=0.001). Of the eyes with PDVR in uncontrolled diabetes mellitus 165 out of 229 (72%) lost distance vision (p=0.00014). All patients with serious macular edema and an HbA(1c) of ≥9.5% lost 5 m distance in vision. The mean HbA(1c) in all patients who experienced postoperative blindness was 13.5%. Postoperative vision was significantly better in children operated for trauma complications (p=0.046) whereby patients with contusion of the globe had a significantly better final result (p=0.0302) than patients with penetrating injuries. Revision surgery was indicated most frequently after surgery for proliferative vitreoretinopathy due to prior retinal detachment surgery.
The most frequent causes of preventable retinal blindness in Oman are pediatric trauma and advanced diabetic vitreoretinopathy. Eyes operated for trauma had a better outcome than PDVR in patients with uncontrolled diabetes mellitus. The large number of eyes with PDVR in the final stages and sequelae of trauma legitimates preventive medical measures and an expansion of vitreoretinal services with supportive external training of specialists and allied health professions.
中东国家的玻璃体视网膜疾病目前在重要性方面排在白内障、沙眼和青光眼之后。本研究报告了阿曼玻璃体视网膜疾病最常见的病因以及玻璃体视网膜手术的结果，以便深入了解培训和设备方面的需求。
在5年期间进行了人口统计学数据和生物显微镜检查。使用Accurus 800CS（爱尔康）和EyeLite® 532 nm激光（爱尔康）进行玻璃体切除术，用5600 cs硅油（阿达托梅德）或C₃F₈ Ispan（爱尔康）进行眼内填充，成人使用5.5×7.5 mm 507型椭圆形硅海绵巩膜扣带（格德），儿童（12岁以下）使用3.0×5.0 mm 506型椭圆形硅海绵巩膜扣带（格德），用涤纶线平行于角膜缘缝合。术后4周和1年对患者进行随访。通过描述性统计（费舍尔精确检验和χ²检验）对数据进行评估。
2002年至2006年，对784只成人眼和101只儿童眼进行了2910例玻璃体视网膜手术。主要适应证在成人中为增殖性糖尿病性玻璃体视网膜病变（PDVR）（229/784只眼 = 29%），其次是外伤（166/784 = 21%）和增殖性玻璃体视网膜病变（PVR）性视网膜脱离（112/784 = 14.3%），而在儿童中主要适应证是外伤（73/101只眼 = 73%）。成人中因外伤、PVR性视网膜脱离、视网膜前胶质增生和人工晶状体取出而接受手术的患者术后视力有显著差异且更好（分别为p = 0.003、p = 0.044、p = 0.029、p = 0.001），而患有未控制的2型糖尿病的PDVR患者术后视力有显著差异且更差（p = 0.001）。在患有未控制糖尿病的PDVR患者中，229只眼中有165只（72%）丧失了远视力（p = 0.00014）。所有患有严重黄斑水肿且糖化血红蛋白（HbA1c）≥9.5%的患者丧失了5米的远视力。所有术后失明患者的平均HbA1c为13.5%。因外伤并发症接受手术的儿童术后视力明显更好（p = 0.046），其中眼球挫伤患者的最终结果明显优于穿透伤患者（p = 0.0302）。由于先前的视网膜脱离手术，增殖性玻璃体视网膜病变手术后最常需要进行翻修手术。
阿曼可预防的视网膜失明最常见的病因是儿童外伤和晚期糖尿病性玻璃体视网膜病变。因外伤接受手术的眼睛比患有未控制糖尿病的PDVR患者预后更好。大量处于PDVR晚期和外伤后遗症阶段的眼睛证明了预防医学措施以及通过对专科医生和相关卫生专业人员进行外部支持培训来扩大玻璃体视网膜服务的合理性。
