Velez-Montoya Raul, Jacobo-Oceguera Paola, Flores-Preciado Javier, Dalma-Weiszhausz Jose, Guerrero-Naranjo Jose, Salcedo-Villanueva Guillermo, Garcia-Aguirre Gerardo, Fromow-Guerra Jans, Morales-Canton Virgilio
Retina Department. Asociación para Evitar la Ceguera en México IAP, México City DF, Mexico.
Med Hypothesis Discov Innov Ophthalmol. 2016 Spring;5(1):18-31.
We reviewed all the available data regarding the current management of non-complex rhegmatogenous retinal detachment and aimed to propose a new decision-making algorithm aimed to improve the single surgery success rate for mid-severity rhegmatogenous retinal detachment. An online review of the Pubmed database was performed. We searched for all available manuscripts about the anatomical and functional outcomes after the surgical management, by either scleral buckle or primary pars plana vitrectomy, of retinal detachment. The search was limited to articles published from January 1995 to December 2015. All articles obtained from the search were carefully screened and their references were manually reviewed for additional relevant data. Our search specifically focused on preoperative clinical data that were associated with the surgical outcomes. After categorizing the available data according to their level of evidence, with randomized-controlled clinical trials as the highest possible level of evidence, followed by retrospective studies, and retrospective case series as the lowest level of evidence, we proceeded to design a logical decision-making algorithm, enhanced by our experiences as retinal surgeons. A total of 7 randomized-controlled clinical trials, 19 retrospective studies, and 9 case series were considered. Additional articles were also included in order to support the observations further. Rhegmatogenous retinal detachment is a potentially blinding disorder. Its surgical management seems to depend more on a surgeon´s preference than solid scientific data or is based on a good clinical history and examination. The algorithms proposed herein strive to offer a more rational approach to improve both anatomical and functional outcomes after the first surgery.
我们回顾了所有关于非复杂性孔源性视网膜脱离当前治疗方法的可用数据，旨在提出一种新的决策算法，以提高中度至重度孔源性视网膜脱离单次手术的成功率。我们对PubMed数据库进行了在线检索。我们搜索了所有关于通过巩膜扣带术或原发性玻璃体切除术治疗视网膜脱离后解剖和功能结果的可用手稿。检索仅限于1995年1月至2015年12月发表的文章。对检索获得的所有文章进行了仔细筛选，并手动查阅了它们的参考文献以获取更多相关数据。我们的检索特别关注与手术结果相关的术前临床数据。在根据证据水平对可用数据进行分类后，以随机对照临床试验为最高证据水平，其次是回顾性研究，回顾性病例系列为最低证据水平，我们结合作为视网膜外科医生的经验，着手设计一种逻辑决策算法。共纳入了7项随机对照临床试验、19项回顾性研究和9个病例系列。还纳入了其他文章以进一步支持这些观察结果。孔源性视网膜脱离是一种潜在致盲性疾病。其手术治疗似乎更多地取决于外科医生的偏好，而非可靠的科学数据，或者是基于良好的临床病史和检查。本文提出的算法力求提供一种更合理的方法，以改善首次手术后的解剖和功能结果。
