Lira Rodrigo Pessoa Cavalcanti, Takasaka Iuuki, Arieta Carlos Eduardo Leite, Nascimento Mauricio Abujamra, Caldato Roberto, Panetta Heitor
Department of Ophthalmology, State University of Campinas, Recife, Brazil.
Arch Ophthalmol. 2010 Dec;128(12):1519-22. doi: 10.1001/archophthalmol.2010.271.
To compare the reattachment rate and visual acuity results among patients with rhegmatogenous retinal detachment who underwent scleral buckle surgery with retinopexy by intraoperative cryotherapy (cryopexy) vs postoperative (1 month later) laser photocoagulation (laserpexy).
Eighty-six patients with rhegmatogenous retinal detachment scheduled for scleral buckle surgery were randomly assigned to the cryopexy or laserpexy group.
The primary outcome was the 1-week reattachment rate. Other outcome measures included later reattachment rate (1 month and 6 months), best-corrected visual acuity, rate of subsequent operations, and postoperative complications.
The 1-week, 1-month, and 6-month anatomical success rates were similar in the 2 groups: 93% (40 patients), 100%, and 100% in the cryopexy group and 95% (41 patients), 100%, and 100% in the laserpexy group, respectively. Three patients in the cryopexy group and 2 in the laserpexy group underwent 1 additional rhegmatogenous retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The types of postoperative complications were similar in both groups, except for eyelid edema. Visual recovery was slower in the cryotherapy group, but the difference in visual acuity after 6 months was not significant.
In patients with uncomplicated retinal detachment, both techniques of retinopexy have shown satisfactory anatomical and functional success. Laserpexy offers faster visual acuity recuperation with fewer postoperative complications but requires a second intervention and costs more than cryotherapy.
Laserpexy is a successful alternative to cryopexy in creating chorioretinal adhesion for scleral buckle surgery.
clinicaltrials.gov Identifier: NCT01068379.
比较接受巩膜扣带术联合视网膜固定术的孔源性视网膜脱离患者，术中冷冻疗法（冷冻固定术）与术后（1个月后）激光光凝术（激光固定术）的视网膜复位率和视力结果。
86例计划接受巩膜扣带术的孔源性视网膜脱离患者被随机分配至冷冻固定术组或激光固定术组。
主要观察指标为1周时的视网膜复位率。其他观察指标包括后期视网膜复位率（1个月和6个月时）、最佳矫正视力、后续手术率及术后并发症。
两组患者1周、1个月和6个月时的解剖学成功率相似：冷冻固定术组分别为93%（40例患者）、100%和100%，激光固定术组分别为95%（41例患者）、100%和100%。冷冻固定术组有3例患者和激光固定术组有2例患者在1周随访时初次手术失败后又接受了1次孔源性视网膜脱离手术（玻璃体视网膜切除术）。两组术后并发症类型相似，但眼睑水肿情况除外。冷冻疗法组视力恢复较慢，但6个月后的视力差异无统计学意义。
在无并发症的视网膜脱离患者中，两种视网膜固定术均显示出令人满意的解剖学和功能学成功率。激光固定术视力恢复更快，术后并发症更少，但需要二次干预，且费用高于冷冻疗法。
在巩膜扣带术中，激光固定术是冷冻固定术形成脉络膜视网膜粘连的成功替代方法。
clinicaltrials.gov标识符：NCT01068379。
