Okonkwo O N, Hassan A O, Oderinlo O
Department of Ophthalmology, Eye Foundation Hospital; Eye Foundation Retina Institute, 27 Isaac John Street, GRA, Ikeja, Lagos, Nigeria.
Niger J Clin Pract. 2020 Mar;23(3):337-342. doi: 10.4103/njcp.njcp_158_19.
To present the anatomical and visual outcome and compare different techniques in the surgical treatment of proliferative vitreoretinopathy (PVR) in Nigerians.
Comparative retrospective review of PVR grade C and D eyes that had vitreoretinal surgery with silicone oil between April 2005 and December 2012. Data was extracted from consecutive case notes after exclusion of eyes with PVR associated with proliferative diabetic retinopathy (PDR), proliferative sickle cell retinopathy (PSCR) and eyes with nonuse of silicone oil. A comparison of the outcome of vitrectomy alone (Vit.), versus combined with a scleral buckle (Vit.+SB), versus with retinectomy (Vit.+RT), versus with all three procedures (Vit.+SB+RT) was done. Statistical analysis was done using the Statistical Package for Social Sciences version 16 software. Pearson Chi-square test and Fisher's exact T-test were used to determine the effect of relationships.
138 eyes of 138 patients had grades C (100 eyes) and grade D (38 eyes) PVR. Surgery involved vitrectomy and membrane peel in 53% of eyes, additional scleral buckle in 22%, and retinectomy was performed in 17%. Retinal reattachment rate was 86% for PVR C eyes and 87% in PVR D eyes. There was no statistically significant difference in anatomical outcome between vitrectomy alone and the combination surgeries. In the vitrectomy only category, the postoperative vision was noted to improve (> preoperative), in 48% of PVR C and in 31% of PVR D. 33% of PVR C and 44% of PVR D eyes had a worse vision (< preoperative). Visual outcome was similarly poor in the combination surgeries with improved vision noted in 12%, 44%, and 33% of the Vit.+SB, Vit. +RT, and Vit.+SB+RT PVR C eyes, respectively. In PVR D eyes, improved vision was seen in 57% and 12% of Vit.+SB and Vit.+RT eyes, respectively.
Surgery results in anatomical reattachment and there is nonsuperiority of any technique. Visual outcome is poor as previously reported. Recent trials of pharmacological adjuncts may show promise for improved visual outcomes.
介绍尼日利亚人增生性玻璃体视网膜病变（PVR）手术治疗的解剖学和视觉结果，并比较不同技术。
对2005年4月至2012年12月间接受硅油填充玻璃体视网膜手术的C级和D级PVR患眼进行回顾性比较研究。排除合并增殖性糖尿病视网膜病变（PDR）、增殖性镰状细胞视网膜病变（PSCR）的PVR患眼以及未使用硅油的患眼后，从连续的病例记录中提取数据。比较单纯玻璃体切除术（Vit.）、联合巩膜扣带术（Vit.+SB）、联合视网膜切除术（Vit.+RT）以及三种手术联合（Vit.+SB+RT）的结果。使用社会科学统计软件包第16版软件进行统计分析。采用Pearson卡方检验和Fisher精确t检验来确定各关系的影响。
138例患者的138只眼中有C级（100只眼）和D级（38只眼）PVR。53%的患眼手术包括玻璃体切除术和膜剥除术，22%的患眼额外进行了巩膜扣带术，17%的患眼进行了视网膜切除术。PVR C级患眼的视网膜复位率为86%，PVR D级患眼为87%。单纯玻璃体切除术与联合手术在解剖学结果上无统计学显著差异。在单纯玻璃体切除术组中，48%的PVR C级患眼和31%的PVR D级患眼术后视力提高（>术前）。33%的PVR C级患眼和44%的PVR D级患眼视力变差（<术前）。联合手术的视觉结果同样较差，在Vit.+SB、Vit. +RT和Vit.+SB+RT的PVR C级患眼中，视力提高的分别占12%、44%和33%。在PVR D级患眼中，Vit.+SB和Vit.+RT患眼中视力提高的分别占57%和12%。
手术可实现解剖学复位，且任何一种技术均无优势。视觉结果如先前报道的那样较差。近期药物辅助治疗的试验可能有望改善视觉结果。
