Jackson Timothy L, Donachie Paul H J, Johnston Robert L
*Department of Ophthalmology, King's College London, London, United Kingdom; and †Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom.
Retina. 2016 Oct;36(10):1897-905. doi: 10.1097/IAE.0000000000001012.
To audit the natural history of vitreomacular traction, and the risks and benefits of surgery.
Database study of 1,254 patients (1,399 eyes) with vitreomacular traction from 16 UK vitreoretinal units.
The median age was 75 years, with 36.2% of patients diagnosed as diabetic. In 986 (70.5%) eyes managed conservatively, the median presenting logarithm of the minimum angle of resolution visual acuity of 0.30 (Snellen 20/40) was unchanged over follow-up. Of 413 eyes (29.5%) that required pars plana vitrectomy, the median preoperative visual acuity improved from 0.60 to 0.50 (20/80-20/63), 6 months to 12 months after surgery, with 33% gaining at least 0.3 units (approximately 2 Snellen lines). Vitrectomy was combined with internal limiting membrane peel in 43.8%, epiretinal membrane peel in 42.4%, gas/air tamponade in 46.2%, and cataract surgery in 27.9%. One or more intraoperative complications occurred in 12.6%; most commonly retinal breaks (8.0%), retinal trauma (1.9%), and retinal hemorrhage (1.0%). Postoperative retinal detachment occurred in 2.7% and macular hole in 2.2%. The 1, 2, and 3 year rates of postvitrectomy cataract surgery were 28.2%, 38.2%, and 42.7%, respectively.
Many eyes with vitreomacular traction have stable visual acuity. Those progressing to vitrectomy have relatively modest visual acuity gains, and complications are not infrequent.
评估玻璃体黄斑牵拉的自然病程以及手术的风险和益处。
对来自英国16个玻璃体视网膜单位的1254例（1399只眼）玻璃体黄斑牵拉患者进行数据库研究。
患者中位年龄为75岁，36.2%的患者被诊断为糖尿病。在986只（70.5%）接受保守治疗的眼中，随访期间最小分辨角视力的初始对数中位数为0.30（Snellen 20/40），保持不变。在413只（29.5%）需要行玻璃体切割术的眼中，术后6个月至12个月，术前视力中位数从0.60提高到0.50（20/80 - 20/63），33%的患者视力至少提高0.3个单位（约2行Snellen视力表）。43.8%的患者在玻璃体切割术中联合内界膜剥除，42.4%联合视网膜前膜剥除，46.2%联合气体/空气填塞，27.9%联合白内障手术。12.6%的患者发生一种或多种术中并发症；最常见的是视网膜裂孔（8.0%）、视网膜损伤（1.9%）和视网膜出血（1.0%）。术后视网膜脱离发生率为2.7%，黄斑裂孔发生率为2.2%。玻璃体切割术后白内障手术的1年、2年和3年发生率分别为28.2%、38.2%和42.7%。
许多玻璃体黄斑牵拉患者的视力稳定。那些需要进行玻璃体切割术的患者视力提高相对有限，且并发症并不少见。
