Teke Mehmet Y, Balikoglu-Yilmaz Melike, Yuksekkaya Pinar, Citirik Mehmet, Elgin Ufuk, Kose Timur, Ozturk Faruk
*Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey; †Department of Ophthalmology, Dr. Behcet Uz Children Disease and Surgery Training and Research Hospital, Izmir, Turkey; ‡Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey.
Retina. 2014 Oct;34(10):1926-38. doi: 10.1097/IAE.0000000000000204.
To analyze the surgical outcomes and retinal redetachment frequency after silicone oil (SO) removal for complex retinal detachment.
This institutional-based study included 894 consecutive patients who underwent pars plana vitrectomy with SO endotamponade for complicated retinal detachment. The effects of preoperative best-corrected visual acuity, vitreous base shaving, intraoperative scleral buckling, retinectomy, SO viscosity, duration of SO, and vitreous hemorrhage at the first postoperative week on the risk of redetachment were investigated.
During a mean follow-up of 39.9 months, anatomical success was not achieved in 118 patients (13.2%) after SO removal. On multivariate analysis, risk factors for recurrent retinal detachment included giant retinal tear (adjusted odds ratio [aOR], 12.39; P < 0.001), high myopia (aOR, 2.70; P = 0.011), surgeries without scleral buckling (aOR, 1.97; P = 0.039), inadequate vitreous base shaving (aOR, 117.62; P < 0.001), and vitreous hemorrhage at the first postoperative week (aOR, 12.13; P < 0.001).
Retinal detachment etiology, inadequate vitreous base shaving, lack of intraoperative scleral buckling, and vitreous hemorrhage at the first postoperative week after SO removal were significant risk factors for retinal redetachment after SO removal, but preoperative visual acuity, SO viscosity, and duration of SO had no significant effect on redetachment.
分析复杂视网膜脱离硅油取出术后的手术效果及视网膜再脱离发生率。
本基于机构的研究纳入了894例连续接受玻璃体切除联合硅油眼内填充治疗复杂性视网膜脱离的患者。研究了术前最佳矫正视力、玻璃体基底部切除、术中巩膜扣带术、视网膜切除术、硅油黏度、硅油填充时间以及术后第一周玻璃体出血对再脱离风险的影响。
在平均39.9个月的随访期间,118例(13.2%)患者硅油取出术后未获得解剖学成功。多因素分析显示,视网膜再脱离的危险因素包括巨大视网膜裂孔(校正比值比[aOR],12.39;P<0.001)、高度近视(aOR,2.70;P = 0.011)、未行巩膜扣带术的手术(aOR,1.97;P = 0.039)、玻璃体基底部切除不充分(aOR,117.62;P<0.001)以及术后第一周玻璃体出血(aOR,12.13;P<0.001)。
视网膜脱离病因、玻璃体基底部切除不充分、术中未行巩膜扣带术以及硅油取出术后第一周玻璃体出血是硅油取出术后视网膜再脱离的重要危险因素,但术前视力、硅油黏度及硅油填充时间对再脱离无显著影响。