Department of Ophthalmology, Academic Medical Center, University of Amsterdam, The Netherlands.
Am J Ophthalmol. 2011 Jun;151(6):995-8. doi: 10.1016/j.ajo.2011.01.005. Epub 2011 Mar 31.
To assess the risks of vitrectomy for the removal of primary and secondary vitreous opacities.
Retrospective, nonrandomized, interventional case series.
We reviewed the results of 116 consecutive cases of vitrectomy for vitreous floaters. Eighty-six cases were primary and 30 cases were secondary floaters. Main outcome measures were the incidence of iatrogenic retinal breaks and postoperative rhegmatogenous retinal detachments.
We found iatrogenic retinal breaks in 16.4% of operations. There was no statistically significant difference in risk between cases of primary and secondary floaters. Intraoperative posterior vitreous detachment induction was found to increase significantly the risk of breaks. Retinal detachment occurred in 3 cases (2.5%), all after operations for primary floaters. One case of complicated retinal detachment ended with a low visual acuity of hand movements. Cataract occurred in 50% of phakic cases. Transient postoperative hypotony was found after 5.2% of our operations, and transient postoperative high intraocular pressure was encountered in 7.8%. An intraoperative choroidal hemorrhage occurred in 1 case, which resolved spontaneously. The mean visual acuity improved from 0.20 to 0.13 logarithm of the minimal angle of resolution units.
The risk profile of vitrectomy for floaters is comparable with that of vitrectomy for other elective indications. Retinal breaks are a common finding during surgery and treatment of these breaks is crucial for the prevention of postoperative retinal detachment. Patients considering surgery for floaters should be informed specifically about the risks involved.
评估玻璃体切除术治疗原发性和继发性玻璃体混浊的风险。
回顾性、非随机、干预性病例系列研究。
我们回顾了 116 例连续玻璃体切除术治疗玻璃体浮游物的结果。86 例为原发性浮游物，30 例为继发性浮游物。主要观察指标为医源性视网膜裂孔和术后孔源性视网膜脱离的发生率。
我们发现 16.4%的手术中存在医源性视网膜裂孔。原发性和继发性浮游物病例的风险无统计学差异。术中后玻璃体脱离诱导显著增加了裂孔的风险。3 例（2.5%）发生视网膜脱离，均为原发性浮游物手术后。1 例复杂视网膜脱离导致手动视力低。50%的有晶状体眼病例发生白内障。我们的 5.2%手术出现短暂性术后低眼压，7.8%手术出现短暂性术后高眼压。1 例术中出现脉络膜出血，自行缓解。平均视力从 0.20 提高到 0.13 最小角分辨率对数单位。
玻璃体切除术治疗浮游物的风险与玻璃体切除术治疗其他选择性适应证的风险相当。视网膜裂孔是手术中的常见发现，治疗这些裂孔对于预防术后视网膜脱离至关重要。考虑进行浮游物手术的患者应特别告知相关风险。
