Vitreoretinal Department, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK.
Br J Ophthalmol. 2011 Sep;95(9):1234-8. doi: 10.1136/bjo.2010.190306. Epub 2010 Dec 13.
To identify preoperative features associated with surgical failure following vitrectomy using data collected in a large, prospective randomised controlled trial. Outcomes of patients who redetached were then examined in more detail.
615 patients were analysed as part of an randomised controlled trial investigating the use of 5-fluorouracil and low-molecular-weight heparin. Treatment status had no effect on success rates and did not therefore form part of the analyses. Failure was defined as retinal redetachment within 6 months of primary vitrectomy. Univariate logistic regression analysis was used to assess association between failure and putative risk factors (age, pathological myopia, intraocular pressure, vitreous haemorrhage, previous lens extraction, uveitis, number of retinal quadrants detached, number and distribution of retinal breaks, and grade C proliferative vitreoretinopathy (PVR)). Additional characteristics of patients were then elucidated including number of operations required to achieve retinal reattachment, surgical techniques used and final logMAR visual acuity.
96 patients (15.6%) redetached following surgery, and 37 failed due to PVR. Surgical failure was associated with number of retinal quadrants detached (OR per increase, 1.69 (1.33 to 2.15) p<0.001) and grade C PVR (OR 3.98 (1.47 to 10.73) p=0.006). Inferior breaks were not identified as a risk factor (p=0.602). Repeat retinal detachment surgery showed a trend towards reduced visual acuity at 6 months providing PVR did not develop. PVR resulted in a significant deterioration in visual acuity.
The extent of retinal detachment and preoperative PVR are risk factors for surgical failure following vitrectomy for primary retinal detachment. PVR was again confirmed as the major factor influencing visual outcomes.
通过在大型前瞻性随机对照试验中收集的数据，确定玻璃体切除术后手术失败相关的术前特征。然后更详细地检查再次脱离的患者的结果。
615 名患者作为一项研究 5-氟尿嘧啶和低分子量肝素应用的随机对照试验的一部分进行了分析。治疗状况对成功率没有影响，因此不作为分析的一部分。失败定义为原发性玻璃体切除术后 6 个月内视网膜再次脱离。采用单变量逻辑回归分析评估失败与潜在危险因素（年龄、病理性近视、眼内压、玻璃体积血、既往晶状体摘除、葡萄膜炎、脱离的视网膜象限数、视网膜裂孔数量和分布以及 C 级增生性玻璃体视网膜病变（PVR））之间的关系。然后阐明了患者的其他特征，包括实现视网膜再附着所需的手术次数、使用的手术技术和最终的对数最小视角视力。
96 名患者（15.6%）手术后再次脱离，37 名患者因 PVR 失败。手术失败与脱离的视网膜象限数（每增加一个的比值比，1.69（1.33 至 2.15），p<0.001）和 C 级 PVR（比值比 3.98（1.47 至 10.73），p=0.006）相关。未发现下方裂孔是危险因素（p=0.602）。如果没有发生 PVR，则再次进行视网膜脱离手术显示出 6 个月时视力略有下降的趋势。PVR 导致视力明显恶化。
原发性视网膜脱离玻璃体切除术后手术失败的危险因素是视网膜脱离的程度和术前 PVR。再次证实 PVR 是影响视力结果的主要因素。
