Baumgarten Sabine, Schiller Petra, Hellmich Martin, Walter Peter, Agostini Hansjürgen, Junker Bernd, Helbig Horst, Lommatzsch Albrecht, Mazinani Babac
Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2018 Nov;256(11):2069-2073. doi: 10.1007/s00417-018-4106-6. Epub 2018 Aug 23.
To test if an encircling band improves outcomes in vitrectomy for pseudophakic retinal detachment (PRD) with inferior or with multiple (4 or more) breaks.
Subgroup analysis of a prospective randomized controlled multicenter trial in patients with uncomplicated PRD assigned either to 20 G vitrectomy plus encircling band (group E1), or 20 G vitrectomy without any buckle (group C), or 23/25 G vitrectomy without any buckle (group E2). The primary endpoint was defined as no indication for any retina reattaching procedure during the review period of 6 months. One hundred out of 257 patients were identified with inferior breaks and 63 patients had 4 or more breaks.
In patients with retinal breaks between 5:00 and 7:00, treatment was successful in 77.4% (24/31, treatment arm E1) versus 57.1% (16/28, treatment arm C) (p = 0.301, odds ratio (OR) 1.83, 95% confidence interval (CI) 0.48 to 7.17). In patients with multiple breaks, success rates were 68.2% (15/22, E1) versus. 72.4% (21/29, C, p = 0.46, OR 0.52, CI 0.08-3.65).
Combining an encircling band with vitrectomy in patients with pseudophakic retinal detachment and inferior or multiple breaks does not significantly improve primary anatomical success in comparison to treatment with 20 G or 23/25 G vitrectomy alone.
测试在治疗伴有下方裂孔或多个（4个或更多）裂孔的人工晶状体眼视网膜脱离（PRD）的玻璃体切除术中，环扎带是否能改善手术效果。
对一项前瞻性随机对照多中心试验进行亚组分析，该试验纳入了无并发症的PRD患者，这些患者被随机分配至20G玻璃体切除术联合环扎带组（E1组）、20G玻璃体切除术不联合任何巩膜扣带组（C组）或23/25G玻璃体切除术不联合任何巩膜扣带组（E2组）。主要终点定义为在6个月的观察期内无需进行任何视网膜复位手术。257例患者中，100例被确定存在下方裂孔，63例有4个或更多裂孔。
在视网膜裂孔位于5:00至7:00之间的患者中，治疗成功率在E1组为77.4%（24/31），在C组为57.1%（16/28）（p = 0.301，优势比（OR）为1.83，95%置信区间（CI）为0.48至7.17）。在有多个裂孔的患者中，成功率在E1组为68.2%（15/22），在C组为72.4%（21/29）（p = 0.46，OR为0.52，CI为0.08 - 3.65）。
对于伴有下方或多个裂孔的人工晶状体眼视网膜脱离患者，与单独采用20G或23/25G玻璃体切除术相比，玻璃体切除术联合环扎带并不能显著提高初次解剖复位成功率。
