Marti Marvin, Walton Richard, Böni Christian, Zweifel Sandrine A, Stahel Marc, Barthelmes Daniel
Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Save Sight Institute, The University of Sydney, Sydney, Australia.
Retina. 2017 Dec;37(12):2334-2340. doi: 10.1097/IAE.0000000000001492.
To identify the incidence rate and risk factors for unexplained visual loss associated with silicone oil endotamponade used during primary repair of macula-sparing rhegmatogenous retinal detachments.
This retrospective cohort study included patients undergoing pars plana vitrectomy for primary surgical repair of macula-sparing rhegmatogenous retinal detachments in whom silicone oil endotamponade was used. The primary outcome measure was the incidence rate of unexplained visual loss and identification of risk factors associated with vision loss.
Of 1,218 eyes undergoing pars plana vitrectomy for primary retinal detachment repair, 44 eyes were included for analysis. In 9 eyes (20%), an unexplained vision loss occurred. Logistic regression identified increased intraocular pressure (IOP) (prospectively defined as IOP readings during silicone oil endotamponade ≥21 mmHg on two consecutive visits or ≥25 mmHg at any time during this period) as significant predictor (odds ratio = 4.9; P = 0.04) and a classification tree ranked IOP as the most important variable for vision loss. Incidence rate of vision loss in eyes experiencing IOP increase was 4.5 vision loss events per 1,000 days at risk compared with 1 event per 1,000 days in eyes without IOP increase, yielding an incidence rate ratio of 4.5 (95% confidence interval: 1.1-17.9; P = 0.02).
Sufficient control of IOP during silicone oil endotamponade for primary retinal detachment repair is warranted to reduce the probability of vision loss.
确定在保留黄斑的孔源性视网膜脱离一期修复术中使用硅油眼内填充后不明原因视力丧失的发生率及危险因素。
这项回顾性队列研究纳入了因保留黄斑的孔源性视网膜脱离而接受玻璃体切割联合硅油眼内填充的患者。主要观察指标为不明原因视力丧失的发生率及与视力丧失相关的危险因素。
在1218例行玻璃体切割术治疗原发性视网膜脱离的眼中，44眼纳入分析。9眼（20%）发生了不明原因的视力丧失。逻辑回归分析确定眼内压升高（前瞻性定义为在硅油填充期间连续两次眼压读数≥21 mmHg或在此期间任何时间眼压≥25 mmHg）是显著预测因素（比值比=4.9；P=0.04），分类树分析将眼压列为视力丧失最重要的变量。眼压升高的眼中视力丧失发生率为每1000天有4.5次视力丧失事件，而眼压未升高的眼中为每1000天1次，发生率比为4.5（95%置信区间：1.1-17.9；P=0.02）。
在硅油填充治疗原发性视网膜脱离时，充分控制眼压对于降低视力丧失的可能性是必要的。
