Aljohani Saud, Alshehri Abdulaziz, Al Taisan Abdulaziz, Algorinees Rakan, Semidey Valmore A
King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
King Fahad University Hospital, Alkhobar, Kingdom of Saudi Arabia.
Clin Ophthalmol. 2021 May 7;15:1905-1911. doi: 10.2147/OPTH.S308114. eCollection 2021.
The aim of this study was to report the intraoperative and postoperative complications of vitrectomy for epiretinal membrane (ERM) and macular hole (MH) performed by retinal fellows under direct faculty supervision compared with experienced faculty members.
A total of 271 eyes that underwent pars plana vitrectomy (PPV) for MH and ERM from January 2014 to December 2019 at King Khaled Eye Specialist Hospital were analyzed. PPV for ERM and MH was performed by vitreoretinal fellows and consultants.
The outcome measures assessed were the intraoperative complications rates, such as posterior lens touch, retinal breaks (RBs), retinal detachments, and vitreous hemorrhage. Moreover, the postoperative complications and optical coherence tomography (OCT) changes were assessed upon a minimum follow-up of 6 months. The rate of iatrogenic RB was more common in the ERM than in the MH surgery (15.5% vs 11.2%). Fellows and consultants had a rate of 20.5% of RB during the ERM surgery and 14.6% during MH surgery, respectively. However, these differences were not statistically significant ( = 0.12 for MH and = 0.236 for ERM). Postoperative OCT analysis revealed an MH closure rate of 72.2%, and complete removal of the ERM was achieved in 88.6% in cases performed by fellows, while consultants achieved 61.8% closure rate of MH, and 83.3% of the patients achieved complete removal of ERM.
Macular surgery is overall a safe procedure and the complication rates between fellows and consultants are comparable. With proper supervision, vitreoretinal fellows can achieve equally high anatomical outcomes with few complications.
本研究旨在报告在直接教员监督下，视网膜专科住院医师与经验丰富的教员进行视网膜前膜（ERM）和黄斑裂孔（MH）玻璃体切除术的术中及术后并发症情况，并进行比较。
对2014年1月至2019年12月在沙特国王哈立德眼科专科医院接受玻璃体切割术（PPV）治疗MH和ERM的271只眼进行分析。ERM和MH的PPV由玻璃体视网膜专科住院医师和会诊医师进行。
评估的结果指标包括术中并发症发生率，如晶状体后囊膜接触、视网膜裂孔（RB）、视网膜脱离和玻璃体出血。此外，在至少6个月的随访后评估术后并发症及光学相干断层扫描（OCT）变化。医源性RB发生率在ERM手术中比MH手术更常见（15.5%对11.2%）。专科住院医师和会诊医师在ERM手术中的RB发生率分别为20.5%和14.6%，在MH手术中分别为14.6%和20.5%。然而，这些差异无统计学意义（MH手术中P = 0.12，ERM手术中P = 0.236）。术后OCT分析显示，专科住院医师进行的手术中MH闭合率为72.2%，ERM完全切除率为88.6%，而会诊医师进行的手术中MH闭合率为61.8%，83.3%的患者ERM完全切除。
黄斑手术总体上是一种安全的手术，专科住院医师和会诊医师之间的并发症发生率相当。在适当的监督下，玻璃体视网膜专科住院医师可以获得同样高的解剖学效果，且并发症较少。
