Lee Wei Wei, Bansal Aditya, Sadda Srinivas R, Sarraf David, Berger Alan R, Wong David T, Kertes Peter J, Kohly Radha P, Hillier Roxane J, Muni Rajeev H
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Ophthalmol Retina. 2022 Mar;6(3):234-242. doi: 10.1016/j.oret.2021.09.001. Epub 2021 Sep 11.
To assess the incidence of postoperative outer retinal folds (ORFs) after pars plana vitrectomy (PPV) vs. pneumatic retinopexy (PnR) for rhegmatogenous retinal detachment (RRD) repair and to determine the association of ORFs with functional outcomes at 1 year.
Randomized controlled trial.
Patients with primary macula-off RRD meeting the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized (PIVOT) trial criteria who were randomly assigned to undergo PPV or PnR.
Post hoc analysis of the PIVOT trial. The incidence and quantitative morphologic features of ORFs were assessed using en face and cross-sectional OCT at 1 month postoperatively by 2 masked graders. The ETDRS letter score was measured and quantitative assessment of metamorphopsia was performed at 1 year.
Proportion of patients with ORFs at 1 month postoperatively among those who underwent PPV versus PnR. The secondary outcomes included the association of ORFs with visual acuity (ETDRS letter score) and metamorphopsia via metamorphopsia charts at 12 months postoperatively.
Of 176 participants enrolled in PIVOT, 88 were macula-off RRDs. Of them, 94.3% (83 of 88) underwent postoperative OCT scans that were gradable at month 1, 93.2% (41 of 44) in the PPV group and 95.5% (42 of 44) in the PnR group. The incidence of ORF formation was 34.1% (14 of 41) in the PPV group and 14.3% (6 of 42) in the PnR group (P = 0.034). The ETDRS letter score at 1 year was 65.7 ± 6.6 letters in patients with ORFs vs. 75.1 ± 1.4 letters in those without ORFs (difference = 9.4 letters, 95% confidence interval [CI] = 7.5-11.3, P = 0.047). Among patients in the PPV group alone, the mean ETDRS letter score at 1 year in patients with ORFs was 62.8 ± 24.7 letters, compared with 75.4 ± 9.2 letters in patients without ORF formation (difference = 12.6 letters, 95% CI = 0.05-24.59, P = 0.04). Horizontal and vertical metamorphopsia scores were similar in patients with and without ORFs: horizontal, 0.35 ± 0.12 vs. 0.29 ± 0.07 (difference = 0.06, 95% CI = 0.01-0.11, P = 0.69); vertical, 0.25 ± 0.07 vs. 0.29 ± 0.07 (difference = 0.04, 95% CI = 0-0.08, P = 0.60). There was a negative correlation between the closest distance of an ORF from the fovea and vertical metamorphopsia score (r = -0.507, P = 0.045).
There is greater risk of developing ORFs after PPV compared to PnR for primary RRD. Outer retinal folds at 1 month are associated with significantly worse ETDRS visual acuity letter scores at 1 year.
评估玻璃体切割术（PPV）与气体视网膜固定术（PnR）治疗孔源性视网膜脱离（RRD）后术后视网膜外层皱褶（ORF）的发生率，并确定ORF与1年时功能预后的相关性。
随机对照试验。
符合原发性黄斑脱离RRD的气体视网膜固定术与玻璃体切除术治疗原发性孔源性视网膜脱离疗效随机试验（PIVOT）标准的患者，被随机分配接受PPV或PnR。
对PIVOT试验进行事后分析。术后1个月由2名盲态评分者使用表面和横断面光学相干断层扫描（OCT）评估ORF的发生率和定量形态学特征。在1年时测量早期糖尿病性视网膜病变研究（ETDRS）字母评分并进行变视症的定量评估。
接受PPV与PnR的患者术后1个月出现ORF的比例。次要结局包括ORF与术后12个月时视力（ETDRS字母评分）和通过变视症图表评估的变视症之间的相关性。
在参与PIVOT试验的176名参与者中，88例为黄斑脱离RRD。其中，94.3%（88例中的83例）接受了术后1个月可分级的OCT扫描，PPV组为93.2%（44例中的41例），PnR组为95.5%（44例中的42例）。PPV组ORF形成的发生率为34.1%（41例中的14例），PnR组为14.3%（42例中的6例）（P = 0.034）。有ORF的患者1年时的ETDRS字母评分为65.7±6.6分，无ORF的患者为75.1±1.4分（差值 = 9.4分，95%置信区间[CI] = 7.5 - 11.3，P = 0.047）。仅在PPV组患者中，有ORF的患者1年时的平均ETDRS字母评分为62.8±24.7分，无ORF形成的患者为75.4±9.2分（差值 = 12.6分，95%CI = 0.05 - 24.59，P = 0.04）。有ORF和无ORF的患者水平和垂直变视症评分相似：水平方向，0.35±0.12对0.29±0.07（差值 = 0.06，95%CI = 0.01 - 0.11，P = 0.69）；垂直方向，0.25±0.07对0.29±0.07（差值 = 0.04，95%CI = 0 - 0.08，P = 0.60）。ORF距黄斑中心凹的最近距离与垂直变视症评分之间存在负相关（r = -0.507，P = 0.045）。
与PnR相比，原发性RRD患者接受PPV后发生ORF的风险更高。术后1个月的视网膜外层皱褶与1年时ETDRS视力字母评分显著更差相关。
