印度人群中早产儿视网膜病变继发视网膜脱离行微创玻璃体切割手术的疗效观察。

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population.

机构信息

Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.

出版信息

Indian J Ophthalmol. 2019 Jun;67(6):889-895. doi: 10.4103/ijo.IJO_1030_17.

DOI:10.4103/ijo.IJO_1030_17

PMID:31124510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6552624/

Abstract

PURPOSE

To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP).

METHODS

Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression.

RESULTS

Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6-13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4-4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98-3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4-14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09-0.5, P < 0.005).

CONCLUSION

MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.

摘要

目的

分析并报告 4 期和 5 期早产儿视网膜病变（ROP）的微创玻璃体切割术（MIVS）的结果。

方法

评估了 2012 年 1 月至 2015 年 4 月期间，129 名早产儿的 202 只眼接受 MIVS 治疗 4/5 期 ROP 的医疗记录。主要结局指标为解剖成功的比例（定义为最后一次随访时后极部附着的视网膜）。记录与 MIVS 相关的并发症，并使用逻辑回归分析与不良解剖结果相关的危险因素。

结果

患有 4 期 ROP 的婴儿的就诊年龄（2.9±1.75 个月）低于患有 5 期疾病的婴儿（5.62±2.55 个月）（P<0.005）。117 只眼（56%或 58%）为 5 期，38 只眼（19%）为 4a 期，47 只眼（23%）为 4b 期。94 只眼（47%）接受了先前的治疗（激光和/或抗血管内皮生长因子[VEGF]）。58 只眼（29%）行晶状体保留玻璃体切割术（LSV），144 只眼（71%）行晶状体切除玻璃体切割术（LV）。在平均 32.5 周的随访中，102 只眼（50.5%）达到了解剖成功，包括 4a 和 4b 期的 74%和 5 期的 33%。并发症包括术中裂孔形成（19%）、术后玻璃体积血（28%）、眼内压升高（12.7%）和白内障进展（2.4%）。与良好解剖结果显著相关的因素包括 4 期疾病（与 5 期相比）（优势比[OR]5.8；置信区间[CI]2.6-13.8，P<0.005）、先前的治疗（激光+抗 VEGF）（OR 2.5；CI 1.4-4.7，P<0.005）、25G MIVS 手术（与 23G 相比）（OR：1.7；CI=0.98-3.00，P=0.05）和 LSV（与 LV 相比）（OR 7；CI=3.4-14.6，P<0.005）。视网膜裂孔与不良解剖结果显著相关（OR 0.21；CI=0.09-0.5，P<0.005）。