Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.
Ophthalmology. 2013 Sep;120(9):1809-13. doi: 10.1016/j.ophtha.2013.01.056. Epub 2013 Apr 17.
To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs).
Nonrandomized, multicenter, retrospective study.
One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs.
Reported data included clinical manifestations, the method of repair, and the outcome.
Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate).
The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7×10(-8)).
In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
研究复杂孔源性视网膜脱离（RRD）的治疗结果。
非随机、多中心、回顾性研究。
来自 5 大洲 48 个国家的 176 名外科医生报告了 7678 例 RRD 的初次手术。
报告的数据包括临床表现、修复方法和结果。
视网膜脱离修复失败（一级失败率）、研究结束时仍有硅油（二级失败率）以及需要额外手术修复脱离（三级失败率）。
本研究评估的复杂视网膜脱离的主要类别为：（1）B 级增生性玻璃体视网膜病变（PVR；n = 917），（2）C-1 级 PVR（n = 637），（3）脉络膜脱离或显著低眼压（n = 578），（4）大或巨大视网膜裂孔（n = 1167），和（5）黄斑裂孔（n = 153）。在 B 级 PVR 中，单独巩膜扣带治疗的一级失败率高于玻璃体切割术（P = 0.0017）。在 C-1 级 PVR 中，接受玻璃体切割术、联合或不联合巩膜扣带以及单独巩膜扣带治疗的患者之间，一级失败率无统计学显著差异（P = 0.7）。与未接受扣带的患者相比，接受玻璃体切割术联合补充扣带的患者失败率增加（P = 0.007）。B 级或 C-1 级 PVR 患者中，视网膜下液填充与硅油填充的一级失败率无统计学显著差异。脉络膜脱离或低眼压患者接受玻璃体切割术的失败率明显低于单独巩膜扣带治疗（P = 0.0015）。接受玻璃体切割术治疗的大或巨大视网膜裂孔的失败率也明显低于巩膜扣带治疗（P = 7×10（-8））。
在视网膜脱离患者中，当存在脉络膜脱离、低眼压、大裂孔或巨大裂孔时，玻璃体切割术是首选方法。在 PVR 视网膜脱离中，可以考虑用气体或硅油填充。如果要进行玻璃体切割术，这些数据表明补充扣带可能没有帮助。
作者没有与本文讨论的任何材料有专有的或商业的利益。
