原发性视网膜脱离结局研究：人工晶状体眼视网膜脱离结局：原发性视网膜脱离结局研究报告第 3 号。
Primary Retinal Detachment Outcomes Study: Pseudophakic Retinal Detachment Outcomes: Primary Retinal Detachment Outcomes Study Report Number 3.
机构信息
The Retina Institute, St. Louis, Missouri.
VitreoRetinal Surgery PA, Minneapolis, Minnesota.
出版信息
Ophthalmology. 2020 Nov;127(11):1507-1514. doi: 10.1016/j.ophtha.2020.05.005. Epub 2020 May 8.
PURPOSE
This study evaluates outcomes of comparable pseudophakic rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) or PPV with scleral buckle (PPV-SB).
DESIGN
Multicenter, retrospective, interventional cohort study.
PARTICIPANTS
Data were gathered from patients from multiple retina practices in the United States with RRD in 2015.
METHODS
A large detailed database was generated. Pseudophakic patients with RRD managed with PPV or PPV-SB were analyzed for anatomic and visual outcomes. Eyes with proliferative vitreoretinopathy, giant retinal tears, previous invasive glaucoma surgery, and ≤90 days of follow-up were excluded from outcomes analysis. Single surgery anatomic success (SSAS) was defined as retinal attachment without ongoing tamponade and with no other RRD surgery within 90 days.
MAIN OUTCOME MEASURES
Single surgery anatomic success and final Snellen visual acuity (VA).
RESULTS
A total of 1158 of 2620 eyes (44%) with primary RRD were pseudophakic. A total of 1018 eyes had greater than 90 days of follow-up. Eyes with proliferative vitreoretinopathy, previous glaucoma surgery, and giant retinal tears were excluded, leaving 893 pseudophakic eyes eligible for outcome analysis. A total of 461 (52%) were right eyes. A total of 606 patients (67%) were male, with a mean age of 65±11 years. Pars plana vitrectomy and PPV-SB as the first procedure were performed on 684 eyes (77%) and 209 eyes (23%), respectively. The mean follow-up was 388±161 days, and overall SSAS was achieved in 770 eyes (86%). Single surgery anatomic success was 84% (577/684) for PPV and 92% (193/209) for PPV-SB. The difference in SSAS between types of treatment was significant (P = 0.009). In eyes with macula-on RRD, SSAS was 88% in eyes treated with PPV and 100% in eyes treated with PPV-SB (P = 0.0088). In eyes with macula-off RRD, SSAS was 81% in eyes treated with PPV and 89% in eyes treated with PPV-SB (P = 0.029). Single surgery anatomic success was greater for PPV-SB than PPV for inferior (96% vs. 82%) and superior (90% vs. 82%) detachments. Mean final VA was similar for PPV (20/47) and PPV-SB (20/46; P = 0.805).
CONCLUSIONS
In pseudophakic RRDs, SSAS was better in patients treated with PPV-SB compared with PPV alone, whereas visual outcomes were similar for both groups.
目的
本研究评估了接受经睫状体平坦部玻璃体切除术（PPV）或巩膜扣带术联合经睫状体平坦部玻璃体切除术（PPV-SB）治疗的相似的孔源性视网膜脱离（RRD）患者的结局。
设计
多中心、回顾性、干预性队列研究。
参与者
数据来自美国多家视网膜诊所的 2015 年接受 RRD 治疗的多例患者。
方法
生成了一个大型详细数据库。对接受 PPV 或 PPV-SB 治疗的伴有 RRD 的白内障患者进行解剖学和视力结局分析。排除了患有增生性玻璃体视网膜病变、巨大视网膜裂孔、既往侵袭性青光眼手术以及随访时间≤90 天的患者。单次手术解剖学成功（SSAS）定义为视网膜复位，无持续的眼内填充物以及在 90 天内无需进行其他 RRD 手术。
主要观察指标
单次手术解剖学成功和最终 Snellen 视力（VA）。
结果
在 2620 只原发性 RRD 眼中，有 1158 只（44%）为白内障眼。共有 1018 只眼随访时间超过 90 天。排除了患有增生性玻璃体视网膜病变、既往青光眼手术和巨大视网膜裂孔的患者，留下 893 只白内障眼有资格进行结局分析。其中右眼 461 只（52%）。606 例（67%）患者为男性，平均年龄为 65±11 岁。684 只眼（77%）和 209 只眼（23%）分别接受了 PPV 和 PPV-SB 作为初次手术。平均随访时间为 388±161 天，770 只眼（86%）达到了总体 SSAS。PPV 的 SSAS 为 84%（577/684），PPV-SB 的 SSAS 为 92%（193/209）。两种治疗方法的 SSAS 差异有统计学意义（P=0.009）。在黄斑区受累的 RRD 眼中，接受 PPV 治疗的眼 SSAS 为 88%，接受 PPV-SB 治疗的眼 SSAS 为 100%（P=0.0088）。在黄斑区脱离的 RRD 眼中，接受 PPV 治疗的眼 SSAS 为 81%，接受 PPV-SB 治疗的眼 SSAS 为 89%（P=0.029）。PPV-SB 治疗下眼内下方（96%比 82%）和眼内上方（90%比 82%）RRD 的 SSAS 优于 PPV。PPV 和 PPV-SB 两组的最终平均 VA 相似（20/47 与 20/46；P=0.805）。
结论
在白内障孔源性视网膜脱离患者中，与单独接受 PPV 治疗相比，接受巩膜扣带术联合经睫状体平坦部玻璃体切除术治疗的患者 SSAS 更好，而两组的视力结局相似。
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