Chaker N, Mghaieth F, Chebil A, Bouladi M, El Matri L
Bull Soc Belge Ophtalmol. 2013(322):111-5.
To evaluate the clinical and therapeutic characteristics of rhegmatogenous retinal detachment (RRD) with unseen retinal breaks.
Retrospective study 50 eyes (50 patients) with RRD with unseen retinal breaks in the pre and intraoperative examination. These patients were treated between 2005 and 2010 by vitrectomy or scleral buckling. Retinal breaks were meticulously sought by indentation of the vitreous base. The subretinal fluid was drained by a peripheral retinotomy when a vitrectomy was needed and puncture ab externo when a scleral buckling was performed.
A retinal detachment with unseen retinal breaks accounted for 15% of all RRD operated during this 5-year duration period (2005 - 2010). The average age of our patients was 57 years.Ten were myopic (20%) and 27 (54%) pseudophakic, with inferior RRD in 60% of the cases cases while advanced vitreoretinal proliferation (PVR) greater or equal to stage C in was present in 72%. Primary vitrectomy was performed in 46 cases. Retinal reattachment rate was achieved after a single procedure in 41 eyes (82%). Among them, 40 were operated by vitrectomy and one eye by scleral buckling. The recurrence rate was significantly higher in patients operated by scleral buckling (75%) than by vitrectomy (15%).
RRD with unseen retinal breaks are often seen inferiorly and have a chronic evolution (60%). They concern pseudophakic patients in the majority of the cases. Their poor prognosis and high recurrence rate also appear to be related to an advanced PVR (72%). The good results of primary vitrectomy should be confirmed by randomized studies, especially in phakic eyes.
评估隐匿性视网膜裂孔所致孔源性视网膜脱离（RRD）的临床及治疗特点。
回顾性研究50例（50只眼）术前及术中检查发现隐匿性视网膜裂孔的RRD患者。这些患者于2005年至2010年间接受玻璃体切除术或巩膜扣带术治疗。通过玻璃体基底部压陷仔细寻找视网膜裂孔。需要行玻璃体切除术时，经周边视网膜切开引流视网膜下液；行巩膜扣带术时，经外穿刺引流。
在这5年期间（2005 - 2010年），隐匿性视网膜裂孔所致视网膜脱离占所有接受手术治疗的RRD的15%。患者的平均年龄为57岁。10例为近视患者（20%），27例（54%）为人工晶状体眼，60%的病例为下方RRD，72%的病例存在程度≥C级的晚期玻璃体视网膜增殖（PVR）。46例患者接受了一期玻璃体切除术。41只眼（82%）单次手术后实现视网膜复位。其中，40只眼接受玻璃体切除术，1只眼接受巩膜扣带术。巩膜扣带术治疗的患者复发率（75%）显著高于玻璃体切除术治疗的患者（15%）。
隐匿性视网膜裂孔所致RRD多位于下方，病程呈慢性（60%）。大多数病例累及人工晶状体眼。其预后不良及高复发率似乎也与晚期PVR（72%）有关。一期玻璃体切除术的良好效果应通过随机研究加以证实，尤其是在有晶状体眼中。
