Center of Ophthalmology, Department of Vitreo-Retinal Surgery, University of Cologne, 50924, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2012 Dec;250(12):1731-6. doi: 10.1007/s00417-012-2007-7. Epub 2012 Apr 4.
Surgery for rhegmatogenous retinal detachment (RRD) should usually be performed as soon as possible. However, a risk of operating in an emergency setting has to be considered against the risk of delaying it.
In a retrospective, interventional, non-comparative clinical case series we reviewed the charts of all patients who underwent surgery for primary noncomplex RRD between February 1999 and July 2009. The primary anatomical success (PAS) of RRD surgery was the primary outcome measure, which was defined as permanent reattachment of the retina after a single surgical procedure. All cases were classified as (I) surgical cases, which were performed as emergency procedures the night of the patient's admission to the hospital (emergency setting), and as (II) those cases, which were operated in a routine setting during daytime (routine setting). Visual acuity was documented 2 and 6 months after surgery
1810 cases of primary noncomplex RRD were analysed. PAS rates were 88.0 % in the routine setting and 87.3 % in the emergency setting (p = 0.67). While expert surgeons' PAS rates did not differ between routine and emergency, non-experts achieved inferior anatomical results, when performing surgery in the emergency setting (81.6 % vs. 88.3 %; p = 0.02). There was no difference between expert (87.7 %) and non-expert surgeons (88.6 %) in the routine setting (p = 0.75). There was no statistically significant difference in visual acuity.
Prompt RRD surgery in an emergency setting did not improve the anatomical outcome and was worse if performed by non-expert surgeons. The possibility to schedule surgery may improve delivery of care without compromising the outcome. Although we did not see a significant functional difference, there was a trend for better visual acuity for experts and routine setting. If one decides that prompt surgery is necessary, it should only be done by an experienced vitreoretinal surgeon.
孔源性视网膜脱离（RRD）的手术通常应尽快进行。然而，必须权衡紧急手术的风险与延迟手术的风险。
在一项回顾性、干预性、非对照的临床病例系列研究中，我们回顾了 1999 年 2 月至 2009 年 7 月期间接受原发性非复杂性 RRD 手术的所有患者的病历。RRD 手术的主要解剖成功率（PAS）是主要的观察指标，定义为单次手术后视网膜的永久性复位。所有病例均分为（I）手术病例，这些病例在患者入院当晚作为紧急手术进行（紧急设置），以及（II）那些在白天常规设置下进行的手术（常规设置）。术后 2 个月和 6 个月记录视力。
分析了 1810 例原发性非复杂性 RRD。常规设置中的 PAS 率为 88.0%，紧急设置中的 PAS 率为 87.3%（p=0.67）。虽然专家外科医生在常规和紧急情况下的 PAS 率没有差异，但非专家在紧急情况下进行手术时解剖结果较差（81.6%比 88.3%；p=0.02）。在常规设置中，专家（87.7%）和非专家外科医生（88.6%）之间没有差异（p=0.75）。视力没有统计学上的显著差异。
在紧急情况下进行 RRD 手术并不会改善解剖结果，如果由非专家进行手术则更差。安排手术的可能性可以改善治疗效果而不会影响结果。尽管我们没有看到明显的功能差异，但专家和常规设置的视力有改善趋势。如果决定需要及时手术，应由有经验的玻璃体视网膜外科医生进行。
