Department of Ophthalmology, CHU de Caen, Cote de Nacre, Caen, France.
Centre d'ophtalmologie du Lez, Montferrier sur Lez, France.
Retina. 2020 Jul;40(7):1315-1324. doi: 10.1097/IAE.0000000000002592.
To evaluate the different mechanisms of retinal detachment recurrence after retinectomy for rhegmatogenous retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) and to study its outcome and prognosis.
Retrospective, multicenter study conducted between January 2009 and November 2016. Retrospective review of 56 patients with recurrent RD (RRD) after a first relaxing retinectomy.
The secondary retinal attachment rate was 58.9% (33/56 cases). The various mechanisms of RRD were mainly related to PVR (52/56 cases: 93%). This PVR was anterior in 10 cases (21%), posterior in 31 cases (60%), and combined anterior and posterior in 11 cases (21%). The RRD mechanism was not PVR in 4 of the 56 cases. Some of the RRD mechanisms were specific to retinectomy: fibrosis of the edge of the retinectomy (26 cases: 46.4%), beyond-the-edge proliferation (8 cases: 14.3%), and severe inferior retinal folding (2 cases: 3.6%). In the 2 cases of severe inferior retinal folding, the retina could not be reattached. The anatomical outcome and the mechanism of RRD (anterior PVR, posterior PVR, or combined anterior and posterior PVR) were not correlated (P = 0.12). Visual acuity was significantly better only in patients with complete secondary success, that is, having an attached retina after silicone oil removal: mean preoperative visual acuity was 2.01 logarithm of the minimum angle of resolution versus 1.01 logarithm of the minimum angle of resolution postoperatively (P = 0.019).
Proliferative vitreoretinopathy caused most of the recurrences, and the anatomical outcome did not depend on the type of PVR involved. Only complete secondary success (attached retina after silicone oil removal) was accompanied by visual acuity improvement.
评估增生性玻璃体视网膜病变（PVR）合并孔源性视网膜脱离（RRD）行视网膜光凝术后视网膜脱离复发的不同机制，并研究其结果和预后。
这是一项 2009 年 1 月至 2016 年 11 月进行的回顾性、多中心研究。对首次松解性视网膜光凝术后发生复发性 RRD（RRD）的 56 例患者进行回顾性分析。
二次视网膜贴附率为 58.9%（33/56 例）。RRD 的各种机制主要与 PVR 相关（52/56 例：93%）。10 例（21%）为前 PVR，31 例（60%）为后 PVR，11 例（21%）为前后 PVR 混合。56 例中有 4 例不是 PVR 导致的 RRD 机制。一些 RRD 机制是视网膜光凝术特有的：视网膜光凝术边缘纤维化（26 例：46.4%）、超出边缘增生（8 例：14.3%）和严重下视网膜折叠（2 例：3.6%）。在 2 例严重下视网膜折叠中，视网膜无法再贴附。视网膜解剖学结果和 RRD 机制（前 PVR、后 PVR 或前后 PVR 混合）之间无相关性（P=0.12）。只有在硅油取出后完全二次成功（即视网膜贴附）的患者中，视力明显提高：术前平均视力为 2.01 最小分辨角对数，术后为 1.01 最小分辨角对数（P=0.019）。
增生性玻璃体视网膜病变是导致大部分复发的原因，且解剖学结果与所涉及的 PVR 类型无关。只有完全二次成功（硅油取出后视网膜贴附）才会伴有视力提高。
