Xue Kanmin, Muqit Mahiul M K, Ezra Eric, Charles Stephen J, Yorston David, Mitra Arijit, Patel Chetan K
Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK.
Br J Ophthalmol. 2017 Aug;101(8):1022-1026. doi: 10.1136/bjophthalmol-2016-309750. Epub 2017 Jan 5.
To determine the incidence, presentation and outcomes of progressive sight-threatening retinal detachment (RD) complicating degenerative retinoschisis.
We conducted the first prospective population-based epidemiological study of progressive schisis detachment over a 1-year period (2014-2015) in the UK. Case ascertainment was via monthly British Ophthalmological Surveillance Unit reporting cards sent to all ophthalmologists in the UK. For each reported case, data were collected using incident and 6 months follow-up questionnaires gathering information including demographic, presenting symptoms, retinal findings, primary management, primary outcome, secondary management and secondary outcome.
Fifty-five cases of progressive schisis RD were identified with similar age distribution to conventional rhegmatogenous RD (mean age 64.0 years, range 20-88), and male-to-female ratio of 2.3:1. The locations of schisis detachments were predominantly supratemporal (46.7%) and infratemporal (35.6%). At least 70% of schisis RD were associated with posterior vitreous detachment (PVD) at presentation and 21% with grade B-C proliferative vitreoretinopathy. Primary management consisted of pars plana vitrectomy (82%), scleral buckle (9%), observation (4%), laser (2%) and combined vitrectomy-buckle (2%). Primary reattachment rate was 70%. Final reattachment rate was 87% with mean best-corrected visual acuity of 0.49 Decimal (SD 0.34) for fovea-on and 0.42 Decimal (SD 0.29) for fovea-off schisis detachments at mean follow-up of 8.7 months (SE 1.0).
The estimated annual incidence of progressive schisis RD was 0.85 per million population (95% CI 0.64 to 1.11), equivalent to around 0.66% of all rhegmatogenous RD. PVD may play a key pathogenic role in the development of progressive schisis detachments. Surgical outcomes are inferior to those of conventional rhegmatogenous RD.
确定退行性视网膜劈裂症并发的进行性视力威胁性视网膜脱离（RD）的发病率、临床表现及预后。
我们在英国进行了为期1年（2014 - 2015年）的首次基于人群的进行性劈裂性视网膜脱离前瞻性流行病学研究。通过每月向英国所有眼科医生发送的英国眼科监测单位报告卡来确定病例。对于每例报告病例，使用发病情况和6个月随访问卷收集数据，收集的信息包括人口统计学资料、就诊症状、视网膜检查结果、初始治疗、主要结局、二次治疗及二次结局。
共确定55例进行性劈裂性视网膜脱离病例，其年龄分布与传统孔源性视网膜脱离相似（平均年龄64.0岁，范围20 - 88岁），男女比例为2.3:1。劈裂性视网膜脱离主要位于颞上（46.7%）和颞下（35.6%）。至少70%的劈裂性视网膜脱离在就诊时与玻璃体后脱离（PVD）相关，21%与B - C级增殖性玻璃体视网膜病变相关。初始治疗包括玻璃体切除术（82%）、巩膜扣带术（9%）、观察（4%）、激光治疗（2%）以及玻璃体切除术联合巩膜扣带术（2%）。初始复位率为70%。最终复位率为87%，在平均8.7个月（标准误1.0）的随访中，黄斑在位的劈裂性视网膜脱离最佳矫正视力平均为0.49（标准差0.34），黄斑不在位的为0.42（标准差0.29）。
进行性劈裂性视网膜脱离的估计年发病率为每百万人口0.85例（95%可信区间0.64至1.11），约占所有孔源性视网膜脱离的0.66%。PVD可能在进行性劈裂性视网膜脱离的发生发展中起关键致病作用。手术效果低于传统孔源性视网膜脱离。
