Dave Vivek Pravin, Pappuru Rajeev R, Pathengay Avinash, Tyagi Mudit, Narayanan Raja, Jalali Subhadra
Smt. Kanuri Santhamma Center for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India.
Retina and Vitreous Service, LV Prasad Eye Institute, Visakhapatnam, India.
Semin Ophthalmol. 2019;34(1):47-51. doi: 10.1080/08820538.2018.1551907. Epub 2018 Nov 29.
The purpose of the study is to report the prognostic factors and outcomes of vitrectomy (PPV) with silicone oil tamponade in rhegmatogenous retinal detachment (RRD) secondary to acute retinal necrosis (ARN). This retrospective, non-randomized, interventional comparative study included 38 eyes of 38 patients. All cases underwent PPV with silicone oil tamponade. The main outcome measure was improvement of final visual acuity relative to the presenting visual acuity and factors affecting the same Group A included eyes with favorable vision of 20/400 or better and Group B included the others. Group A included 16 eyes (42.10%), group B included 22 eyes (57.89%). In Group A 2 eyes out of 16 (12.5%) and in Group B 12 eyes out of 22 (54.54%) had RRD at presentation ( = 0.02, 95% CI for the difference 7.88-65.78%). The time interval between first presentation and development of RRD in Group A was 30.94 ± 38.8 days (median 30 days) whereas that in Group B was 10.81 ± 11.73 days (median 8 days) ( = 0.02). The odds of visual improvement post-vitrectomy when RRD occurred later was 8.4 ( = 0.01, 95% CI 1.53-46.1). The usage of systemic steroids (odds 5.2, = 0.03, 95% CI 1.14-23.54) and oral valacyclovir (odds 4.33, = 0.04, 95% CI 1.05-17.84) were associated with odds favoring a good visual outcome. Recurrent RRD was noted in 3/16 eyes (18.75%) in Group A and 13/22 eyes (59.09%) in Group B ( = 0.03). Delayed occurrence of RRD after ARN is a good prognostic factor. Usage of systemic steroids and oral valacylocvir are associated with a favorable visual outcome when started before the onset of RRD.
本研究旨在报告急性视网膜坏死（ARN）继发孔源性视网膜脱离（RRD）行玻璃体切除术（PPV）联合硅油填充的预后因素及结果。这项回顾性、非随机、干预性对照研究纳入了38例患者的38只眼。所有病例均接受了PPV联合硅油填充。主要观察指标是最终视力相对于初诊视力的改善情况以及影响视力改善的因素。A组包括初诊视力20/400或更好的患眼，B组包括其他患眼。A组有16只眼（42.10%），B组有22只眼（57.89%）。A组16只眼中有2只眼（12.5%）初诊时即发生RRD，B组22只眼中有12只眼（54.54%）初诊时即发生RRD（P = 0.02，差异的95%CI为7.88 - 65.78%）。A组初诊至发生RRD的时间间隔为30.94±38.8天（中位数30天），而B组为10.81±11.73天（中位数8天）（P = 0.02）。RRD发生较晚时玻璃体切除术后视力改善的几率为8.4（P = 0.01，95%CI为1.53 - 46.1）。全身应用类固醇（几率5.2，P = 0.03，95%CI为1.14 - 23.54）和口服伐昔洛韦（几率4.33，P = 0.04，95%CI为1.05 - 17.84）与视力良好预后的几率相关。A组16只眼中有3只眼（18.75%）出现复发性RRD，B组22只眼中有13只眼（59.09%）出现复发性RRD（P = 0.03）。ARN后RRD延迟发生是一个良好的预后因素。在RRD发生前开始全身应用类固醇和口服伐昔洛韦与良好的视力预后相关。
