Meng Zi-jun, Gao Yong-feng, Wang Yan-ting
Henan Eye Institute, Henan Eye Hospital,Zhengzhou 450003, China. Email:
Henan Eye Institute, Henan Eye Hospital,Zhengzhou 450003, China.
Zhonghua Yan Ke Za Zhi. 2013 Dec;49(12):1075-80.
To investigate the incidence, duration and consequences of persistent submacular fluid after pars plana vitrectomy (PPV) and scleral buckling surgery (SB) in rhegmatogenous retinal detachment, thus to explore the clinical association between persistent SMF and different surgical methods, and simultaneously, to study the effect of persistent submacular fluid on visual outcome.
It was a retrospective case-series study. Ninety-two qualified eyes including 54 eyes of males and 38 eyes of females with rhegmatogenous retinal detachment which had been performed PPV or SB were recruited. The average age of the patients was (45.8 ± 15.3) years with a age-range from 15 to 76 years. The inclusion criteria was as follows, the macula-off rhegmatogenous retinal detachments without macular hole and obvious proliferative vitreoretinopathy, the retina was completely reattached 1 month after operation and no redetachment was found by ophthalmoscope and B scan till the last follow-up, the minimal follow-up time was 1 year and the submacular fluid must have been dissolved for at least 6 months. All patients underwent thorough ophthalmologic examinations before and after operation, Those patients in whom a persistent submacular fluid was seen on optical coherence tomography (OCT) at 1 month after operation performed follow-up with repeat of the investigations at 3, 6 and 12 months after surgery, If the abnormality resolved, further observations were continued to undertake for 6 months or more till the last follow-up.Rank-sum test, χ²-test and Fisher exact test were applied respectively to analyze for statistical analysis.
The incidence of persistent submacular fluid at 1 month after surgery in the PPV and SB group was 13.9% (5/36) and 48.2% (27/56).Six months later however, the figure expressed as percentage was 2.8% (1/36) and 23.2% (18/28) correspondingly. Persistent submacular fluid was more frequent in eyes with inferior breaks (64.3%) than that with superior ones (13.9%), making a significant differences (χ² = 17.38, P < 0.01) . The persistent submacular fluid group showed worse best-corrected visual acuity than no persistent submacular fluid group 6 and 12 months after surgery (t = 2.525, t = 2.254, both P < 0.05). Comparing the visual acuity (VA) between the eyes with or without persistent submacular fluid 6, 12 months after surgery and the latest followed-up among the ever suffered eyes, a statistically significant differences presented in late stages(average VA: 0.47 ± 0.29, 0.30 ± 0.16; 0.44 ± 0.28, 0.27 ± 0.15;0.42 ± 0.22, 0.27 ± 0.19; t = 2.114, 2.207, 2.068; all P < 0.05), though there were no significant differences in the first three months (average VA: 0.70 ± 0.33, 0.63 ± 0.37; 0.50 ± 0.25,0.45 ± 0.22; t = 0.556, 0.601; both P > 0.05).
Persistent submacular fluid presents in both surgical procedures but it is more frequent after buckling surgery than vitrectomy, the selection of patients, the location of retinal breaks and the duration of detachment may be the potential influencing factors. Persistent submacular fluid after retinal detachment surgery is responsible for delayed recovery, and may affect the final visual outcome. The longer it lasts, the more harm may it do.
探讨孔源性视网膜脱离行玻璃体切割术（PPV）和巩膜扣带术（SB）后持续性黄斑下液的发生率、持续时间及后果，从而探究持续性黄斑下液与不同手术方法之间的临床关联，同时研究持续性黄斑下液对视力预后的影响。
这是一项回顾性病例系列研究。纳入92例符合条件的孔源性视网膜脱离患者，其中男性54例，女性38例，均接受了PPV或SB手术。患者平均年龄为（45.8±15.3）岁，年龄范围为15至76岁。纳入标准如下：黄斑脱离的孔源性视网膜脱离，无黄斑裂孔及明显增生性玻璃体视网膜病变；术后1个月视网膜完全复位，直至最后一次随访，经检眼镜和B超检查均未发现再脱离；最短随访时间为1年，黄斑下液必须至少已消退6个月。所有患者在手术前后均接受了全面的眼科检查。术后1个月经光学相干断层扫描（OCT）发现有持续性黄斑下液的患者，在术后3、6和12个月重复进行检查进行随访。若异常情况消失，则继续观察6个月或更长时间直至最后一次随访。分别应用秩和检验、χ²检验和Fisher确切检验进行统计学分析。
PPV组和SB组术后1个月持续性黄斑下液的发生率分别为13.9%（5/36）和48.2%（27/56）。然而，6个月后，相应的百分比分别为2.8%（1/36）和23.2%（18/28）。下方裂孔的眼中持续性黄斑下液更为常见（64.3%），高于上方裂孔的眼（13.9%），差异有统计学意义（χ² = 17.38，P < 0.01）。术后6个月和12个月，持续性黄斑下液组的最佳矫正视力比无持续性黄斑下液组差（t = 2.525，t = 2.254，P均< 0.05）。比较术后6、12个月及最后一次随访时曾出现持续性黄斑下液的眼与未出现者的视力（VA），晚期差异有统计学意义（平均VA：0.47±0.29，0.30±0.16；0.44±0.28，0.27±0.15；0.42±0.22，0.27±0.19；t = 2.114，2.207，2.068；P均< 0.05），但前三个月差异无统计学意义（平均VA：0.70±0.33，0.63±0.37；0.50±0.25，0.45±0.22；t = 0.556，0.601；P均> 0.05）。
两种手术方式均会出现持续性黄斑下液，但巩膜扣带术后比玻璃体切割术后更常见，患者的选择、视网膜裂孔的位置和脱离持续时间可能是潜在影响因素。视网膜脱离手术后的持续性黄斑下液会导致恢复延迟，并可能影响最终视力预后。其持续时间越长，危害可能越大。
