Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey.
Department of Ophthalmology, Muğla Sıtkı Koçman University, Muğla, Eyalet/Yerleske, Turkey.
Eur J Ophthalmol. 2021 Nov;31(6):3284-3293. doi: 10.1177/1120672120976038. Epub 2020 Nov 24.
To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR).
The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively.
After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period.
The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 ( = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period.
Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.
评估一种新的眼内丝裂霉素 C（MMC）应用技术在伴有进展性增生性玻璃体视网膜病变（PVR）的严重外伤性视网膜脱离（RD）治疗中的解剖和视觉效果。
回顾性分析了 14 例 15 只眼接受玻璃体视网膜手术和术中 MMC 应用的患者记录。
在完成复杂的玻璃体视网膜手术程序（经睫状体平坦部玻璃体切除术、PVR 膜剥离、大视网膜切开术/视网膜切除术以及如果发现眼内异物则取出等）后，用全氟碳液体（PFCL）将视网膜附着，并进行部分液-气交换。进行眼内激光。将 PFCL 去除到视网膜脉络膜伤口、裂孔或视网膜切开部位的后缘。剩余的 PFCL 足以覆盖并防止 MMC 与包括视盘、黄斑和下方 RPE 以及主要血管弓在内的后部重要结构接触。使用眼内的空气保护睫状上皮和其他前段结构免受 MMC 接触。然后，小心地将 10μg/mL 浓缩 MMC 溶液注射到 PFCL 气泡上方，直到覆盖 PVR 或 PVR 发展的潜在区域，60 秒后去除。最后，去除剩余的 PFCL，所有眼睛均充满硅油。硅油取出后至少随访 6 个月。在随访期间确定视觉和解剖结果。
平均随访时间为 19.6±6 个月（范围 12-27 个月）。在随访期间，约 100%的视网膜在一次玻璃体视网膜手术后附着。任何一只眼的视网膜裂孔或视网膜切开部位周围均未检测到 PVR。在两只眼中检测到有限的黄斑视网膜前膜，并在硅油取出时将其剥离。术前视力为手动视力的有 7 只眼，光感的有 8 只眼。15 只眼中有 9 只在随访期间视力 ⩾0.1。术前平均视力为 logMAR 2.16±0.15，术后视力为 0.80±0.50（ = 0.001）。随访期间无与术中使用 MMC 相关的其他并发症。
在伴有 PVR 或有发生 PVR 高风险的外伤性 RD 或这些 RD 接受玻璃体视网膜手术后，临时眼内 MMC 应用可获得良好的解剖和视觉效果。此外，MMC 应用似乎可防止玻璃体视网膜手术后进一步发生 PVR。
