Bond-Taylor Martin, Jakobsson Gunnar, Zetterberg Madeleine
Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal.
Department of Clinical Neuroscience/Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Clin Ophthalmol. 2017 Sep 18;11:1689-1695. doi: 10.2147/OPTH.S143898. eCollection 2017.
The present study aimed to describe clinical characteristics of patients with posterior vitreous detachment (PVD), to determine the prevalence of retinal tears in PVD patients, and to find predictors for retinal tears in this patient group.
Retrospective analysis of medical records on patients diagnosed with PVD, retinal tears, or vitreous hemorrhage at the Department of Ophthalmology at Sahlgrenska University Hospital, a tertiary eye center.
Between February and July 2009, 365 patients consulted the Department of Ophthalmology for PVD-related symptoms. The incidence of retinal tears was 14.5% (n=53) and that of vitreous and/or retinal hemorrhage was 22.7% (n=83). For analysis of possible predictors for complications to PVD, patients diagnosed with retinal tears or vitreous hemorrhage between May and July 2009 were also included in the study, resulting in a total of 426 patients. Predictors of a retinal tear were symptoms of visual impairment (=0.024), the presence of vitreous or retinal hemorrhage at examination (<0.001), and a duration of symptoms for <24 hours (=0.004). Symptoms of flashes did not constitute an extra risk of retinal tears (=0.135). Subsequent retinal pathology (follow-up time 4.5 years), including vitreous detachment/hemorrhage or retinal tears/detachment, occurred more often in patients presenting with a retinal tear. For patients with a retinal tear, the relative risk of having a retinal detachment in the same eye during the follow-up time was 17.7 when compared to patients without a retinal tear (risk ratio 17.7, 95% confidence interval 2.2-145).
Patients seeking care on the first day have a higher risk of retinal tears. Also, symptoms of visual loss or a history of previous PVD-related pathology and vitreous/retinal hemorrhage at examination indicate a substantially higher risk of retinal complications. These findings may lead to better management and order of priority among these patients.
本研究旨在描述玻璃体后脱离（PVD）患者的临床特征，确定PVD患者视网膜裂孔的患病率，并找出该患者群体中视网膜裂孔的预测因素。
对在三级眼科中心萨尔格伦斯卡大学医院眼科诊断为PVD、视网膜裂孔或玻璃体出血的患者的病历进行回顾性分析。
2009年2月至7月期间，365例患者因PVD相关症状到眼科就诊。视网膜裂孔的发生率为14.5%（n = 53），玻璃体和/或视网膜出血的发生率为22.7%（n = 83）。为了分析PVD并发症的可能预测因素，2009年5月至7月期间诊断为视网膜裂孔或玻璃体出血的患者也被纳入研究，共计426例患者。视网膜裂孔的预测因素包括视力损害症状（P = 0.024）、检查时存在玻璃体或视网膜出血（P < 0.001）以及症状持续时间<24小时（P = 0.004）。闪光症状并非视网膜裂孔的额外风险因素（P = 0.135）。后续视网膜病变（随访时间4.5年），包括玻璃体脱离/出血或视网膜裂孔/脱离，在出现视网膜裂孔的患者中更常发生。对于有视网膜裂孔的患者，与没有视网膜裂孔的患者相比，随访期间同一只眼发生视网膜脱离的相对风险为17.7（风险比17.7，95%置信区间2.2 - 145）。
首日就诊的患者发生视网膜裂孔的风险更高。此外，视力丧失症状或既往有PVD相关病变史以及检查时存在玻璃体/视网膜出血表明视网膜并发症的风险显著更高。这些发现可能有助于对这些患者进行更好的管理和确定优先顺序。
