Mafi Mostafa, Mirghorbani Masoud, Ghahvehchian Hossein, Mohammadi S Saeed, Riazi-Esfahani Hamid, Khalili Pour Elias, Mahmoudi Alireza, Khojasteh Hassan, Modjtahedi Bobeck S
Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA.
Ophthalmol Ther. 2020 Sep;9(3):641-651. doi: 10.1007/s40123-020-00279-1. Epub 2020 Jul 14.
Scleral buckling (SB) tends to be more challenging and time-consuming for compared to the pars plana vitrectomy for repairing rhegmatogenous retinal detachments (RRDs). This study characterizes a novel and simplified technique for SB.
In this single-masked randomized interventional study, patients with RRDs who were eligible for SB were randomly assigned to either the standard (S) or modified (M) technique of SB. In the modified approach, neither intraoperative break localization nor cryopexy or subretinal fluid drainage was done. A large tire (276/279) was placed where preoperative retinal breaks had been localized with a 240 encircling band placed for support of the remaining retina. Patients were followed for 12 months and the primary outcomes were differences between the surgical groups in operative time, anatomical success, visual acuity, and complication rate.
Thirty-six eyes were included in the study (18 in each arm). There were no differences in baseline patient demographics or characteristics including gender, age, lens and macular status, preoperative vision, and symptom duration. The mean length of surgery was 72.2 ± 13.2 and 56.2 ± 9.5 min in groups S and M, respectively (P = 0.001). Complete retinal reattachment at the end of month 12 after single surgery was 80.6% overall; 77.8% (14/18) in group S and 83.3% (15/18) in group M (P > 0.999). After 12 months, both groups achieved similar final best-corrected visual acuity (BCVA): 0.26 ± 0.23 and 0.23 ± 0.17 logMAR in groups S and M, respectively (P = 0.231). Controlling for preoperative BCVA on ANCOVA testing, there were no significant differences in visual improvement between the two groups [F (1,26) = 0.02, P = 0.966 (95% CI) - 0.128 to 0.123)]. Scleral perforation (2:1), vitreous hemorrhage (3:2), and transient rise of intraocular pressure (3:4) all occurred at a low and similar rate between the two groups (S:M).
Modified SB technique was non-inferior compared to the standard approach for anatomical and visual outcomes. Shortening surgical time while maintaining low complication rates makes this an appropriate approach to SB, especially for vitreoretinal surgery trainees.
与用于修复孔源性视网膜脱离（RRD）的玻璃体切割术相比，巩膜扣带术（SB）往往更具挑战性且耗时更长。本研究描述了一种新颖且简化的巩膜扣带术技术。
在这项单盲随机干预性研究中，符合巩膜扣带术条件的RRD患者被随机分配至巩膜扣带术的标准（S）技术组或改良（M）技术组。在改良方法中，术中不进行裂孔定位、冷冻治疗或视网膜下液引流。在术前视网膜裂孔定位处放置一个大轮胎（276/279），并用240环扎带环绕以支撑剩余视网膜。对患者进行12个月的随访，主要结局是手术组在手术时间、解剖学成功率、视力和并发症发生率方面的差异。
该研究纳入了36只眼（每组18只）。患者的基线人口统计学特征或特点，包括性别、年龄、晶状体和黄斑状态、术前视力及症状持续时间，均无差异。S组和M组的平均手术时长分别为72.2±13.2分钟和56.2±9.5分钟（P = 0.001）。单次手术后第12个月末的完全视网膜复位率总体为80.6%；S组为77.8%（14/18），M组为83.3%（15/18）（P>0.999）。12个月后，两组的最终最佳矫正视力（BCVA）相似：S组和M组分别为0.26±0.23和0.23±0.17 logMAR（P = 0.231）。在协方差分析中对术前BCVA进行控制后，两组之间的视力改善无显著差异[F(1,26)=0.02，P = 0.966（95%CI）-0.128至0.123]。巩膜穿孔（2:1）、玻璃体积血（3:2）和眼压短暂升高（3:4）在两组（S:M）中均以低且相似的发生率出现。
改良巩膜扣带术技术在解剖学和视力结局方面与标准方法相比并不逊色。缩短手术时间同时保持低并发症发生率，使得该方法成为巩膜扣带术的一种合适选择，尤其对于玻璃体视网膜手术实习生而言。
