Hocaoglu Mumin, Karacorlu Murat, Giray Ersoz M, Sayman Muslubas Isil, Arf Serra
Istanbul Retina Institute, Istanbul, Turkey.
Biruni University School of Medicine, Istanbul, Turkey.
Eur J Ophthalmol. 2021 Apr 22:11206721211012848. doi: 10.1177/11206721211012848.
To describe the treatment outcomes and prognostic factors of retinotomy/retinectomy for rhegmatogenous retinal detachment (RD) complicated anterior inferior proliferative vitreoretinopathy (PVR).
Retrospective, nonrandomized, single-center case series. The outcomes of 126 cases of retinotomy/retinectomy for RD complicated by advanced (Grade C) anterior inferior PVR managed consistently by one surgeon during a 15-year period were evaluated.
Forty-two eyes (33%) had primary RDs and 84 (67%) had recurrent RDs. The extent of retinotomy/retinectomy varied: 90° in 21 eyes (17%), >90° to <180° in 49 eyes (39%), and ⩾180° to ⩽240° in 56 eyes (44%). The retinotomy/retinectomy location was peripheral in 58 eyes (46%) and equatorial in 68 eyes (54%). The mean follow-up period was 43 ± 42 months. The silicone oil (SO) was removed from 98% of the eyes. The single-operation success rate after the primary retinectomy was 87%, and the final attachment rate was 94%. Visual acuity improved from 20/630 to 20/160 ( < 0.001). Vision ⩾20/200 was achieved in 101 eyes (80%). Good visual outcome was correlated positively with preoperative VA ( = 0.02), previous vitrectomy with gas tamponade ( = 0.007), and was negatively correlated with number of previous RD operations ( = 0.01), larger extent of RD ( = 0.02) and more extensive retinotomy/retinectomy ( = 0.04).
An appropriate and timely intervention, including vitrectomy alone, inferior relaxing retinotomy/retinectomy and standard SO tamponade provide satisfactory outcomes for RDs complicated by PVR. Lesser extension of grade C PVR at baseline, such as PVR limited to one quadrant should encourage vitreoretinal specialists to consider retinotomy/retinectomy at a milder clinical stage of PVR development.
描述视网膜切开术/视网膜切除术治疗孔源性视网膜脱离（RD）合并前下方增殖性玻璃体视网膜病变（PVR）的治疗效果及预后因素。
回顾性、非随机、单中心病例系列研究。评估了15年间由一名外科医生持续管理的126例因RD合并晚期（C级）前下方PVR而接受视网膜切开术/视网膜切除术的病例的治疗效果。
42只眼（33%）为原发性RD，84只眼（67%）为复发性RD。视网膜切开术/视网膜切除术的范围各不相同：21只眼（17%）为90°，49只眼（39%）为>90°至<180°，56只眼（44%）为⩾180°至⩽240°。视网膜切开术/视网膜切除术的位置在周边部的有58只眼（46%），在赤道部的有68只眼（54%）。平均随访时间为43±42个月。98%的眼硅油被取出。初次视网膜切除术后单次手术成功率为87%，最终复位率为94%。视力从20/630提高到20/160（<0.001）。101只眼（80%）达到视力⩾20/200。良好的视力预后与术前视力（=0.02）、既往玻璃体切除术联合气体填塞（=0.007）呈正相关，与既往RD手术次数（=0.01）、RD范围较大（=0.02）及视网膜切开术/视网膜切除术范围更广（=0.04）呈负相关。
适当及时的干预，包括单纯玻璃体切除术、下方松解性视网膜切开术/视网膜切除术及标准的硅油填塞，可为合并PVR的RD提供满意的治疗效果。基线时C级PVR范围较小，如PVR局限于一个象限，应促使玻璃体视网膜专科医生在PVR发展的较轻临床阶段考虑行视网膜切开术/视网膜切除术。
