Dimitrios Brouzas, Krassas George, Dettoraki Maria, Lavaris Anastasios, Sideri Anna-Maria, Droutsas Konstantinos, Moschos Marilita M
Department of Ophthalmology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Clin Ophthalmol. 2020 Sep 15;14:2679-2686. doi: 10.2147/OPTH.S241479. eCollection 2020.
To assess the anatomic and functional outcomes of eyes undergoing vitrectomy and large retinectomy for the management of retinal detachment (RD) complicated by advanced proliferative vitreoretinopathy (PVR).
A total of 66 eyes of 63 patients with RD complicated by PVR were treated with vitrectomy and 180° or more retinectomy and silicone oil (n=46) or perfluoropropane gas (n=20) were used as intraocular tamponades.
Retinal reattachment was achieved in 89.39% (59 eyes) of the cases. The mean follow-up was 33.7 months (range 12-76 months). In gas-filled eyes, the final anatomic success rate was 85% (17 eyes) and in silicone oil-filled eyes was 91.3% (42 eyes) (p=0.46). After the initial retinectomy, the total anatomic success rate was 80.3% (53/66 eyes), 70% in gas-filled eyes (14/20 eyes) and 84.79% in silicone oil-filled eyes (39/46 eyes) (p=0.19). Visual acuity (VA) improved in 37 (56.06%) eyes, remained the same in 19 (28.78%) eyes and became worse in 10 (15.15%) cases. Best corrected VA was ≥20/200 in 22 eyes 33.33%. The final VA was associated with the preoperative VA (r=0.68), the preoperative status of the macula influence significantly the final visual acuity (p<0.0001) and there is statistically significant difference in the final visual acuity between eyes with and without anatomic success (p<0.05).
The large circumferential retinectomies can be beneficial in eyes with RD complicated by advanced PVR. No significant difference was found in anatomic success rate, and rate of complications between eyes with silicone oil tamponade and long acting gas undergoing large retinectomy. Regarding the final BCVA, slight difference was found in favor of gas-filled eyes.
评估接受玻璃体切除术和大范围视网膜切除术治疗复杂性视网膜脱离（RD）合并晚期增生性玻璃体视网膜病变（PVR）患者的解剖和功能结局。
63例RD合并PVR患者的66只眼接受了玻璃体切除术，180°及以上视网膜切除术，并使用硅油（n = 46）或全氟丙烷气体（n = 20）作为眼内填充物。
89.39%（59只眼）的病例实现视网膜复位。平均随访时间为33.7个月（范围12 - 76个月）。在填充气体的眼中，最终解剖成功率为85%（17只眼），在填充硅油的眼中为91.3%（42只眼）（p = 0.46）。初次视网膜切除术后，总解剖成功率为80.3%（53/66只眼），填充气体的眼中为70%（14/20只眼），填充硅油的眼中为84.79%（39/46只眼）（p = 0.19）。37只眼（56.06%）视力（VA）提高，19只眼（28.78%）保持不变，10只眼（15.15%）变差。最佳矫正视力（BCVA）≥20/200的有22只眼（33.33%）。最终视力与术前视力相关（r = 0.68），术前黄斑状态对最终视力有显著影响（p < 0.0001），解剖成功与未成功的眼之间最终视力有统计学显著差异（p < 0.05）。
大范围环形视网膜切除术对RD合并晚期PVR的眼有益。在接受大范围视网膜切除术的眼中，硅油填充和长效气体填充的眼在解剖成功率和并发症发生率方面无显著差异。关于最终的最佳矫正视力，发现填充气体的眼有轻微优势。
