Kikushima Wataru, Imai Akira, Hirano Takao, Iesato Yasuhiro, Toriyama Yuichi, Murata Masako, Murata Toshinori
From the *Department of Ophthalmology, Shinshu University School of Medicine; and †Department of Ophthalmology, National Hospital Organization, Matsumoto Medical Center, Matsumoto, Nagano, Japan.
Asia Pac J Ophthalmol (Phila). 2014 May-Jun;3(3):141-5. doi: 10.1097/APO.0b013e3182a81240.
This study aimed to evaluate the consultation and referral pathway and benefit of urgent surgery within 24 hours of outpatient clinic presentation on increasing the ratio of eyes with fovea-on at surgery and visual outcomes in retinal detachment cases.
This is a retrospective, interventional case series.
A total of 106 eyes underwent an operation for rhegmatogenous retinal detachment. Standard vitrectomy or explant scleral buckling was performed. The ratio of eyes with fovea-on at the time of operation, anatomical success rate, and postoperative best corrected visual acuity were measured.
Of the106 eyes, 46 (43.4%) already were fovea-off at initial eye clinic visit, and 9 eyes became fovea-off during referral. Consequently, 55 patients (51.9%) were fovea-off when presenting to our outpatient clinic. Retinal detachment was within 1 disc diameter of the fovea in 9 of 51 eyes with fovea-on at outpatient clinic presentation, but surgery within 24 hours spared 6 eyes from foveal involvement. The anatomical success rate of primary surgery was 98.8% (81/82 eyes) by vitrectomy and 83.3% (20/24 eyes) by scleral buckling. Postoperative best corrected visual acuity of the fovea-on group was significantly higher (mean [SD], -0.019 [0.22] logarithm of the minimal angle of resolution) than that of the fovea-off group (mean [SD], 0.32 [0.45] logarithm of the minimal angle of resolution; P = 0.002).
More than half (51.9%) of our cohort had already been fovea-off by outpatient presentation. Therefore, efforts to urge patients to visit operating facilities promptly seem to be as important as the urgent surgeries themselves.
本研究旨在评估门诊就诊后24小时内紧急手术的会诊和转诊途径以及益处，以提高视网膜脱离病例手术时黄斑中心凹在位眼的比例和视觉预后。
这是一项回顾性干预性病例系列研究。
共有106只眼接受了孔源性视网膜脱离手术。采用标准玻璃体切除术或外加压巩膜扣带术。测量手术时黄斑中心凹在位眼的比例、解剖成功率和术后最佳矫正视力。
106只眼中，46只眼（43.4%）在初次眼科门诊就诊时黄斑中心凹已脱离，9只眼在转诊过程中黄斑中心凹脱离。因此，55例患者（51.9%）在到我们门诊就诊时黄斑中心凹已脱离。门诊就诊时黄斑中心凹在位的51只眼中，有9只眼的视网膜脱离距离黄斑中心凹在1个视盘直径范围内，但24小时内进行手术使6只眼未累及黄斑。玻璃体切除术的一期手术解剖成功率为98.8%（81/82只眼），巩膜扣带术为83.3%（20/24只眼）。黄斑中心凹在位组的术后最佳矫正视力显著高于黄斑中心凹脱离组（平均[标准差]，最小分辨角对数为-0.019[0.22]）（平均[标准差]，最小分辨角对数为0.32[0.45]；P = 0.002）。
我们队列中超过一半（51.9%）的患者在门诊就诊时黄斑中心凹已脱离。因此，督促患者及时前往手术机构就诊的努力似乎与紧急手术本身同样重要。
