Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
Great Ormond Street Hospital for Children, London, UK.
Eye (Lond). 2022 Aug;36(8):1590-1596. doi: 10.1038/s41433-021-01679-8. Epub 2021 Jul 21.
To audit the structural and functional outcomes of surgery for acute tractional retinal detachment due to retinopathy or prematurity between 2004 and 2014 in Oxford UK.
Consecutive operations were identified from a surgical log. Clinical data including demography, perioperative data, and retinal outcomes were extracted into a spreadsheet and compared against two international data sets referenced in the method section. Nonparametric tests (Fisher's exact, and the Mann-Whitney U-tests) were used for statistical analysis with a p-value < 0.05 considered significant.
Twenty-nine eyes of 19 babies underwent surgery. The mean age (SD) at final follow-up was 6.4 (3.7) years of age and comparable to the reference data sets. The mean birth weight and gestational age of babies matched the ETROP data set referenced in the method section. Anatomical success was obtained in 16/29 (55.2%) of eyes and more likely with stage 4 ROP than stage 5 disease (p < 0.05). Thirteen of 29 eyes (44.8%) obtained form vision post-operatively. All instances of macular retinal reattachment during follow up were verified with post-operative OCT.
Surgery for stage 5 ROP is not worthwhile. For stage 4 ROP it yielded better visual outcomes than ETROP but registration for visual impairment was not prevented. Innovation such as endoscopic vitrectomy could yield better outcomes. Earlier detection of vitreoretinal fibrosis could result in timelier referral. A formally funded national service is needed to ring-fence resource to avoid delays in access to surgery, which has a narrow surgical window.
对英国牛津 2004 年至 2014 年间因视网膜病变或早产导致的急性牵引性视网膜脱离手术的结构和功能结果进行审核。
从手术日志中确定连续手术。提取临床数据（包括人口统计学、围手术期数据和视网膜结果）到电子表格中，并与方法部分中引用的两个国际数据集进行比较。使用非参数检验（Fisher 精确检验和 Mann-Whitney U 检验）进行统计分析，p 值<0.05 被认为具有统计学意义。
19 名婴儿的 29 只眼接受了手术。最终随访时的平均年龄（SD）为 6.4（3.7）岁，与参考数据集相当。婴儿的平均出生体重和胎龄与方法部分中引用的 ETROP 数据集相匹配。29 只眼中有 16 只（55.2%）获得了解剖学成功，且 stage 4 ROP 的成功率高于 stage 5 疾病（p<0.05）。29 只眼中有 13 只（44.8%）术后获得了有用视力。所有在随访中黄斑视网膜再附着的情况都通过术后 OCT 得到了证实。
stage 5 ROP 的手术没有价值。对于 stage 4 ROP，手术的视觉结果优于 ETROP，但未能预防视力损害的登记。内镜玻璃体切除术等创新可能会产生更好的结果。更早地发现玻璃体细胞纤维增生可能会导致更及时地转介。需要建立一个有资金支持的国家服务，以隔离资源，避免因手术机会狭窄而导致的手术延误。
