Department of Ophthalmology & Visual Science, Yale University School of Medicine, Yale University Eye Center, New Haven, Connecticut.
Department of Ophthalmology & Visual Science, Yale University School of Medicine, Yale University Eye Center, New Haven, Connecticut.
Ophthalmology. 2014 Sep;121(9):1715-9. doi: 10.1016/j.ophtha.2014.03.012. Epub 2014 Apr 22.
To identify risk factors associated with failure of anatomic reattachment in primary rhegmatogenous retinal detachment repair.
Nonrandomized, multicenter, collaborative study.
Primary procedures for 7678 rhegmatogenous retinal detachments reported by 176 surgeons from 48 countries.
We recorded specific preoperative clinical findings, repair method, and outcome after intervention. We performed univariate, bivariate, and multivariate analyses to identify variables associated with surgical failure.
Final failure of retinal detachment repair (level 1), remaining silicone oil at study conclusion (level 2), and need for additional procedures to repair the detachment (level 3).
We analyzed 7678 cases of rhegmatogenous retinal detachment repair. Presence of choroidal detachment or significant hypotony was associated with significantly higher level 1 failure rates when grade 0 or B proliferative vitreoretinopathy (PVR) was present and higher level 2 failure rates, regardless of PVR status (P<0.05). Excluding cases with choroidal detachment or hypotony, increasing PVR was associated with increasing level 1 failure rates. The difference between grade B and C-1 PVR was significant (P = 2 × 10(-6)). No difference was observed in level 1 failure rates when operated eyes were phakic versus pseudophakic. Level 1 failure was significantly higher when all 4 quadrants of retina (4.4%) were detached than when only 1 quadrant (0.8%) had subretinal fluid. With grade B or C-1 PVR, cases with large or giant tears had significantly higher level 1 failure rates. No association was observed between number of retinal breaks and failure rates. Multivariate analysis showed grade C-1 PVR, 4 detached quadrants, and presence of choroidal detachment or significant hypotony were independently linked with a greater level 1 failure rate; the presence of a smaller retinal break was associated with a lesser level 1 failure rate.
Choroidal detachment, significant hypotony, grade C-1 PVR, 4 detached quadrants, and large or giant retinal breaks were independent explanatory variables of retinal detachment repair failure. In contrast to earlier studies, the significance of phakic versus pseudophakic status was not confirmed.
确定原发性孔源性视网膜脱离修复后解剖复位失败的相关风险因素。
非随机、多中心、协作研究。
来自 48 个国家的 176 名外科医生报告的 7678 例原发性孔源性视网膜脱离的初次手术。
我们记录了特定的术前临床发现、修复方法和干预后的结果。我们进行了单变量、双变量和多变量分析，以确定与手术失败相关的变量。
视网膜脱离修复的最终失败（水平 1）、研究结束时仍存在硅油（水平 2）以及需要进行额外手术修复脱离（水平 3）。
我们分析了 7678 例孔源性视网膜脱离修复手术。当存在 0 级或 B 型增殖性玻璃体视网膜病变（PVR）时，存在脉络膜脱离或显著低眼压与显著较高的水平 1 失败率相关，且无论 PVR 状态如何，水平 2 失败率均较高（P<0.05）。排除脉络膜脱离或低眼压病例后，PVR 增加与水平 1 失败率增加相关。B 级和 C-1 级 PVR 之间的差异具有统计学意义（P = 2×10(-6)）。未发现眼内屈光手术与非眼内屈光手术的水平 1 失败率有差异。当视网膜的所有 4 个象限（4.4%）均脱离时，水平 1 失败率明显高于仅 1 个象限（0.8%）存在视网膜下积液。对于 B 级或 C-1 级 PVR，大或巨大裂孔的病例水平 1 失败率明显较高。视网膜裂孔数量与失败率之间未观察到相关性。多变量分析显示，C-1 级 PVR、4 个脱离象限、脉络膜脱离或显著低眼压是水平 1 失败率较高的独立相关因素；较小的视网膜裂孔与较低的水平 1 失败率相关。
脉络膜脱离、显著低眼压、C-1 级 PVR、4 个脱离象限和大或巨大视网膜裂孔是视网膜脱离修复失败的独立解释变量。与早期研究不同，眼内屈光手术与非眼内屈光手术状态的重要性未得到证实。
