Eliott Dean, Stryjewski Tomasz P, Andreoli Michael T, Andreoli Christopher M
*Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; †Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; ‡Department of Ophthalmology, The University of Illinois at Chicago, Chicago, Illinois; and §Harvard Vanguard Medical Associates, Boston, Massachusetts.
Retina. 2017 Jul;37(7):1229-1235. doi: 10.1097/IAE.0000000000001361.
To determine the incidence of retinal redetachment due to proliferative vitreoretinopathy after open-globe trauma in smokers and nonsmokers.
A total of 892 patients comprising 893 open-globe injuries, in whom 255 eyes were diagnosed with a retinal detachment, and 138 underwent surgical repair were analyzed in a retrospective case-control study. Time to redetachment was examined using the Kaplan-Meier method and analysis of risk factors was analyzed using Cox proportional hazards modeling.
Within one year after retinal detachment surgery, 47% (95% CI, 39-56%) of all 138 repaired retinas redetached because of proliferative vitreoretinopathy. Being a smoker was associated with a higher rate of detachment (adjusted hazard ratio 1.96, P = 0.01). As shown in previous studies, the presence of proliferative vitreoretinopathy at the time of surgery was also an independent risk factor for failure (adjusted hazard ratio 2.13, P = 0.005). Treatment with vitrectomy-buckle compared favorably to vitrectomy alone (adjusted hazard ratio 0.58, P = 0.04). Only 8% of eyes that redetached achieved a best-corrected visual acuity of 20/200 or better, in comparison to 44% of eyes that did not redetach (P < 0.001).
Proliferative vitreoretinopathy is a common complication after the repair of retinal detachment associated with open-globe trauma, and being a smoker is a risk factor for redetachment. Further study is needed to understand the pathophysiologic mechanisms underlying this correlation.
确定吸烟者和非吸烟者开放性眼球外伤后因增殖性玻璃体视网膜病变导致视网膜再次脱离的发生率。
在一项回顾性病例对照研究中，分析了总共892例患者的893只开放性眼球损伤，其中255只眼被诊断为视网膜脱离，138只眼接受了手术修复。使用Kaplan-Meier方法检查再次脱离的时间，并使用Cox比例风险模型分析危险因素。
在视网膜脱离手术后的一年内，所有138只接受修复的视网膜中有47%（95%可信区间，39 - 56%）因增殖性玻璃体视网膜病变而再次脱离。吸烟与更高的脱离率相关（调整后的风险比为1.96，P = 0.01）。如先前研究所示，手术时存在增殖性玻璃体视网膜病变也是手术失败的独立危险因素（调整后的风险比为2.13，P = 0.005）。玻璃体切除术联合巩膜扣带术的治疗效果优于单纯玻璃体切除术（调整后的风险比为0.58，P = 0.04）。再次脱离的眼中只有8%的最佳矫正视力达到20/200或更好，而未再次脱离的眼中这一比例为44%（P < 0.001）。
增殖性玻璃体视网膜病变是开放性眼球外伤相关视网膜脱离修复术后的常见并发症，吸烟是再次脱离的危险因素。需要进一步研究以了解这种相关性背后的病理生理机制。
