Scheerlinck Laura M, Schellekens Peter A, Liem Albert T, Steijns Daan, Leeuwen Redmer van
Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
Retina. 2016 Feb;36(2):342-50. doi: 10.1097/IAE.0000000000000711.
To investigate the incidence, risk factors, and clinical characteristics of unexplained visual loss after macula-on rhegmatogenous retinal detachment (RRD).
Retrospective cohort of patients with primary macula-on rhegmatogenous retinal detachment treated by vitrectomy with gas or silicone oil (SO) tamponade in 2011 and 2012. Outcome was unexplained visual loss (>2 Snellen lines) 2 months after the last vitrectomy.
Incidence of unexplained visual loss was 0.7% (1/151) in patients treated by gas and 29.7% (11/37) in patients treated by SO (P = 0.001). Visual loss occurred both during SO tamponade and after removal. Cases underwent optical coherence tomography, perimetry, microperimetry, fluorescein angiography, and visual evoked potentials. Patients with unexplained visual loss after SO tamponade showed a small scotoma within the central 2° on microperimetry. Duration of SO tamponade was the only statistically significant factor related to the incidence of unexplained visual loss (P = 0.001).
Incidence of SO-related visual loss was 30% with duration of tamponade as the only risk factor. This study is the first to apply microperimetry in these patients, which showed a distinct pattern of a small central scotoma. Therefore, microperimetry can be of great value in the diagnostic workup of patients with unexplained visual loss after vitrectomy.
探讨黄斑在位的孔源性视网膜脱离（RRD）后不明原因视力丧失的发生率、危险因素及临床特征。
回顾性队列研究2011年和2012年接受玻璃体切除联合气体或硅油（SO）填塞治疗的原发性黄斑在位孔源性视网膜脱离患者。结局指标为最后一次玻璃体切除术后2个月不明原因的视力丧失（>2行斯内伦视力表视力）。
气体治疗患者不明原因视力丧失的发生率为0.7%（1/151），硅油治疗患者为29.7%（11/37）（P = 0.001）。视力丧失在硅油填塞期间及取出后均有发生。对病例进行了光学相干断层扫描、视野检查、微视野检查、荧光素血管造影和视觉诱发电位检查。硅油填塞后不明原因视力丧失的患者在微视野检查中显示中央2°范围内有一个小暗点。硅油填塞时间是与不明原因视力丧失发生率相关的唯一具有统计学意义的因素（P = 0.001）。
与硅油相关的视力丧失发生率为30%，填塞时间是唯一的危险因素。本研究首次对这些患者应用微视野检查，显示出中央小暗点的独特模式。因此，微视野检查在玻璃体切除术后不明原因视力丧失患者的诊断检查中可能具有重要价值。
