改善增殖性玻璃体视网膜病变和增殖性糖尿病视网膜病变视网膜复位手术预后的关键因素

Key Factors to Improve the Outcome of Retinal Reattachment Surgery in Proliferative Vitreoretinopathy and Proliferative Diabetic Retinopathy.

作者信息

Deuchler Svenja, Ackermann Hanns, Singh Pankaj, Kohnen Thomas, Wagner Clemens, Koch Frank

机构信息

Vitreoretinal Unit, Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany.

Institute of Biostatistics and Mathematical Modelling, University Hospital, 60590 Frankfurt am Main, Hessen, Germany.

出版信息

J Ophthalmol. 2017;2017:2323897. doi: 10.1155/2017/2323897. Epub 2017 Jul 9.

DOI:10.1155/2017/2323897

PMID:28770107

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5523461/

Abstract

INTRODUCTION

For management of complicated retinal detachments, a pars plana vitrectomy with temporary silicone oil (SO) fill is the method of choice. According to literature, the retinal redetachment rate varies between <10% and >70% with around 36% in our own group (retrospective data analysis, = 119 eyes).

METHODS

The main goal was to reduce the retinal redetachment rate. Standard operating procedures (SOPs) and evaluation protocols (EVALPs) were developed to prospectively analyse risk factors. Lab analysis of SO was performed, and the role of surgical experience was evaluated and investigated with Eyesi®.

RESULTS

We achieved a significant reduction of the retinal redetachment rate (to 6.80%, = 101, = 0.002). After surgery with SO injection, neither further membrane peeling (in 16.5%) nor retinal laser coagulation (in 100%) during revision surgery had a significant effect on the reattachment rate ( = 0.167, = 0.23), while extensive additional laser coagulation reduced visual acuity ( = 0.01). A 3-port approach had to be set up to complete SO removal. A difference in success rate depending on surgical experience was confirmed, and the performance in Eyesi correlated with that in the patients' eye.

CONCLUSIONS

A SOP- and EVALP-based management and new strategies to secure the surgical performance seem to be essential for successful surgery.

摘要

引言

对于复杂视网膜脱离的治疗，选择的方法是采用临时硅油填充的玻璃体切除术。根据文献，视网膜再脱离率在<10%至>70%之间变化，我们自己的研究组（回顾性数据分析，n = 119只眼）约为36%。

方法

主要目标是降低视网膜再脱离率。制定了标准操作程序（SOP）和评估方案（EVALP）以对危险因素进行前瞻性分析。对硅油进行实验室分析，并使用Eyesi®评估和研究手术经验的作用。

结果

我们显著降低了视网膜再脱离率（降至6.80%，n = 101，p = 0.002）。在注射硅油手术后，翻修手术中进一步的膜剥离（16.5%）和视网膜激光光凝（100%）对再附着率均无显著影响（p = 0.167，p = 0.23），而广泛的额外激光光凝会降低视力（p = 0.01）。必须采用三通道方法来完成硅油取出。证实了成功率因手术经验而异，且在Eyesi上的操作表现与患者眼部的表现相关。