Al Bin Ali Ghada Y, Al-Mahmood Ammar M, Khandekar Rajiv, Abboud Emad B, Edward Deepak P, Kozak Igor
*King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; †Department of Ophthalmology, Bahrain Defense Force Hospital, Kingdom of Bahrain; ‡Division of Anterior Segment, Dhahran Eye Specialist Hospital, Dhahran, Kingdom of Saudi Arabia; and §Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Retina. 2017 Oct;37(10):1916-1922. doi: 10.1097/IAE.0000000000001430.
To determine the efficacy and complications of pars plana vitrectomy (PPV) and adjunct surgeries for aqueous misdirection refractory to medical therapy.
A retrospective review of consecutive eyes with refractory aqueous misdirection at the King Khaled Eye Specialist Hospital between 2002 and 2010. Patients underwent two-port and three-port pars plana vitrectomy (PPV) with adjunct procedures including pars plana lensectomy combined with posterior capsulectomy, hyaloido-zonulo-iridectomy, and synechiolysis. Main outcome measures included anatomical success, functional success, and factors associated with the outcomes.
Sixty-nine eyes were evaluated over a mean follow-up period of 17.6 ± 3.8 months (3-156 months). Anatomical success was achieved in 62 eyes (90%) and functional success in 54 eyes (78%) that underwent PPV as a primary surgery. The factors associated with the altering misdirected aqueous flow and reducing intraocular pressure significantly associated with a two-line improvement of best-corrected visual acuity included surgical treatment within 4 weeks of presentation (P = 0.004) and preoperative intraocular pressure (P = 0.001). The success of two-port PPV and standard three-port PPV was similar (P = 0.7). The intraoperative and postoperative complications included retinal detachment in two eyes and endophthalmitis in one eye.
The PPV was effective for managing aqueous misdirection refractory to medical therapy. Two-port or three-port PPV did not change the success rate but early surgery improved both anatomical and functional outcomes.
确定玻璃体切割术（PPV）及辅助手术治疗药物治疗无效的房水引流错向的疗效及并发症。
回顾性分析2002年至2010年在沙特国王哈立德眼科专科医院连续收治的难治性房水引流错向患者。患者接受了两孔和三孔玻璃体切割术（PPV），并辅以包括晶状体玻璃体切除术联合后囊切开术、玻璃体-悬韧带-虹膜切除术及粘连松解术等辅助手术。主要观察指标包括解剖学成功、功能成功以及与预后相关的因素。
共评估69只眼，平均随访时间为17.6±3.8个月（3 - 156个月）。以PPV作为主要手术的62只眼（90%）取得了解剖学成功，54只眼（78%）取得了功能成功。与改变错向的房水引流及降低眼压显著相关且与最佳矫正视力提高两行显著相关的因素包括就诊后四周内进行手术治疗（P = 0.004）及术前眼压（P = 0.001）。两孔PPV与标准三孔PPV的成功率相似（P = 0.7）。术中及术后并发症包括2只眼发生视网膜脱离，1只眼发生眼内炎。
PPV对治疗药物治疗无效的房水引流错向有效。两孔或三孔PPV不改变成功率，但早期手术可改善解剖学及功能预后。
