Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Retina. 2021 Aug 1;41(8):1597-1604. doi: 10.1097/IAE.0000000000003090.
To compare the efficacy and safety between lens-sparing vitrectomy and phacovitrectomy for primary rhegmatogenous retinal detachment treatment according to surgical experience.
We retrospectively reviewed the medical records of 193 patients with primary rhegmatogenous retinal detachment who underwent either lens-sparing vitrectomy (n = 111) or phacovitrectomy (n = 82). Patients were operated by two experienced surgeons or eight vitreoretinal fellows and had a minimum follow-up of 6 months. Anatomical success rate, postoperative complications, and functional outcomes were compared.
Primary anatomical success rate was 92.8% (103/111) for lens-sparing vitrectomy and 91.5% (75/82) for phacovitrectomy (P = 0.733). The fellows had lower success rate after phacovitrectomy compared with the experts, but not statistically significant (85% [34/40] vs. 97.6% [41/42], P = 0.054). During phacovitrectomy, one zonulysis case in the experts group and four posterior capsular rupture cases in the fellows group were noted. Cystoid macular edema was found only after phacovitrectomy (12.2% [10/82]), and epiretinal membrane occurred more after phacovitrectomy than after lens-sparing vitrectomy (28% [23/82] vs. 8.1% [9/111], P < 0.001). There was no difference in the occurrence of cystoid macular edema and epiretinal membrane after phacovitrectomy between two surgeon groups (P = 0.514, 0.701, respectively).
Combined phacoemulsification and vitrectomy has no additional benefit in improving the surgical outcome of primary rhegmatogenous retinal detachment management. Considering the intraoperative and postoperative complications and the relatively low success rate, phacovitrectomy may not be a desirable option in inexperienced surgeons.
根据手术经验，比较晶状体保留性玻璃体切除术和超声乳化白内障吸除联合玻璃体切除术治疗原发性孔源性视网膜脱离的疗效和安全性。
回顾性分析 193 例接受晶状体保留性玻璃体切除术（111 例）或超声乳化白内障吸除联合玻璃体切除术（82 例）治疗的原发性孔源性视网膜脱离患者的病历资料。手术由两位经验丰富的外科医生或八位玻璃体视网膜住院医师完成，随访时间至少 6 个月。比较解剖成功率、术后并发症和功能结果。
晶状体保留性玻璃体切除术的原发性解剖成功率为 92.8%（103/111），超声乳化白内障吸除联合玻璃体切除术为 91.5%（75/82）（P = 0.733）。与专家相比，住院医师行超声乳化白内障吸除联合玻璃体切除术的成功率较低，但差异无统计学意义（85%[34/40]比 97.6%[41/42]，P = 0.054）。在超声乳化白内障吸除联合玻璃体切除术中，专家组发生 1 例后囊膜破裂，住院医师组发生 4 例后囊膜破裂。仅在超声乳化白内障吸除联合玻璃体切除术后发现黄斑囊样水肿（12.2%[10/82]），且超声乳化白内障吸除联合玻璃体切除术后发生视网膜前膜的比例高于晶状体保留性玻璃体切除术（28%[23/82]比 8.1%[9/111]，P < 0.001）。两组外科医生行超声乳化白内障吸除联合玻璃体切除术的黄斑囊样水肿和视网膜前膜发生率无差异（P = 0.514、0.701）。
联合超声乳化白内障吸除和玻璃体切除术不能提高原发性孔源性视网膜脱离治疗的手术效果。考虑到术中及术后并发症发生率以及相对较低的成功率，在经验不足的外科医生中，超声乳化白内障吸除联合玻璃体切除术可能不是理想的选择。
