Ophthalmology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
Medical Statistics, Osaka City University Graduate School of Medicine School of Medicine, Osaka, Japan.
Br J Ophthalmol. 2022 Jun;106(6):857-862. doi: 10.1136/bjophthalmol-2020-318451. Epub 2021 Jan 29.
BACKGROUND/AIMS: To assess the anatomical and visual results of uncomplicated phakic macula-on retinal detachment (RD) in patients treated with pars plana vitrectomy (PPV) or scleral buckling (SB).
A retrospective cohort of patients aged <65 years and diagnosed with uncomplicated phakic macula-on primary RD, who were registered in the Japan-Retinal Detachment Registry, was compiled between February 2016 and March 2017. We performed propensity score matching using preoperative findings and surgeon-related factors as covariates to account for relevant confounders. The primary outcome was anatomical failures at 6 months postoperatively, classified as follows: level 1, an inoperable state; level 2, anatomical recovery with silicone oil tamponade; and level 3, need for additional surgery to repair the detachments. The secondary outcome was change in best-corrected visual acuity (BCVA).
Of the 822 included patients, 552 underwent PPV and 270 underwent SB. After propensity score matching, 137 matched cases between the PPV and SB groups were analysed. The total proportion of surgical failures in the PPV group was higher than that in the SB group (risk difference, 0.10 (0.02 to 0.18), p=0.011, McNemar's test). Conversely, the change in BCVA was not significantly different between the two groups (logMAR units, -0.015 (-0.084 to 0.053), p=0.66, paired samples t-test).
Although the indications for PPV are becoming broader, PPV may not be the optimal approach for repairing all types of RD. Therefore, careful consideration is needed when selecting the right surgical technique for treating uncomplicated phakic macula-on RD cases.
背景/目的：评估接受玻璃体切除术（PPV）或巩膜扣带术（SB）治疗的无复杂性眼后房型有晶状体视网膜脱离（RD）患者的解剖和视力结果。
我们对 2016 年 2 月至 2017 年 3 月期间在日本视网膜脱离登记处注册的年龄<65 岁且被诊断为无复杂性眼后房型原发性 RD 的无复杂性眼后房型有晶状体 RD 患者进行了回顾性队列研究。我们使用术前发现和与外科医生相关的因素作为协变量进行倾向评分匹配，以考虑到相关混杂因素。主要结局是术后 6 个月时的解剖学失败，分为以下等级：1 级，不可手术状态；2 级，硅油填充后解剖学恢复；3 级，需要进行额外手术修复脱离。次要结局是最佳矫正视力（BCVA）的变化。
在 822 例纳入患者中，552 例接受了 PPV，270 例接受了 SB。在进行倾向评分匹配后，对 PPV 和 SB 组之间的 137 例匹配病例进行了分析。PPV 组的手术失败总比例高于 SB 组（风险差异，0.10（0.02 至 0.18），p=0.011，McNemar 检验）。相反，两组间 BCVA 的变化无显著差异（对数最小分辨角对数单位，-0.015（-0.084 至 0.053），p=0.66，配对样本 t 检验）。
尽管 PPV 的适应证正在扩大，但 PPV 可能不是修复所有类型 RD 的最佳方法。因此，在选择治疗无复杂性眼后房型有晶状体 RD 病例的正确手术技术时需要慎重考虑。
