Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom. M. S. Singh is now with the Retina Division, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Vitreoretinal Service, Moorfields Eye Hospital, London, United Kingdom.
Retina. 2018 Feb;38(2):325-330. doi: 10.1097/IAE.0000000000001534.
Posterior hyaloid removal during pars plana vitrectomy and lensectomy for ectopia lentis is commonly performed, but may increase the risk of intraoperative retinal breaks and postoperative retinal detachment. This study evaluated outcomes after pars plana vitrectomy and lensectomy with or without posterior hyaloid removal.
This retrospective observational cohort study included ectopia lentis cases that underwent pars plana vitrectomy and lensectomy (2005-2014), with or without intraoperative induction of a posterior vitreous detachment (PVD). The primary outcome was postoperative retinal detachment. The secondary outcomes were the incidence of iatrogenic retinal breaks, and change in visual acuity.
Twenty-six cases were included. The posterior hyaloid was preserved intraoperatively in 11 cases (non-PVD group). In the remainder (15 cases), the vitreous was removed completely (PVD group). Postoperative retinal detachment occurred in 2 cases in each group (18.2% non-PVD vs.13.3% PVD, P = 0.7). Intraoperative breaks occurred more frequently in the PVD group (2 vs. 9 cases; P = 0.03). There was no difference in mean improvement in visual acuity (7 [PVD] vs. 3 [non-PVD] ETDRS lines; P = 0.2).
The preservation of posterior hyaloid attachment during vitreolensectomy for ectopia lentis was associated with fewer iatrogenic retinal breaks. Postoperative retinal detachment did not seem to be influenced by the choice of surgical technique.
在进行扁平部玻璃体切除术和晶状体切除治疗晶状体异位时，通常会进行后玻璃体膜切除，但这可能会增加术中视网膜裂孔和术后视网膜脱离的风险。本研究评估了行或不行后玻璃体膜切除术联合扁平部玻璃体切除术和晶状体切除术后的结果。
本回顾性观察性队列研究纳入了 2005 年至 2014 年间行扁平部玻璃体切除术和晶状体切除术（伴或不伴术中诱导玻璃体后脱离）治疗晶状体异位的病例。主要结局是术后视网膜脱离。次要结局是医源性视网膜裂孔的发生率和视力变化。
共纳入 26 例病例。11 例（非玻璃体后脱离组）术中保留了后玻璃体膜。其余 15 例（玻璃体后脱离组）完全切除了玻璃体。两组术后均有 2 例发生视网膜脱离（非玻璃体后脱离组 18.2%，玻璃体后脱离组 13.3%，P = 0.7）。玻璃体后脱离组术中裂孔发生率更高（2 例比 9 例；P = 0.03）。视力平均改善程度无差异（玻璃体后脱离组 7 行，非玻璃体后脱离组 3 行 ETDRS 线；P = 0.2）。
在治疗晶状体异位的扁平部玻璃体切除术和晶状体切除术中保留后玻璃体膜附着与较少的医源性视网膜裂孔有关。手术技术的选择似乎对术后视网膜脱离没有影响。
