Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (R.N.I, V.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H).
From The Retina Service of Wills Eye Hospital, Mid Atlantic Retina (M.R.S, R.M, M.S, A.E.K, Y.Y, S.J.G, S.M, C.D.R, J.H).
Am J Ophthalmol. 2022 Aug;240:143-148. doi: 10.1016/j.ajo.2022.02.028. Epub 2022 Mar 12.
To investigate factors associated with good visual acuity (VA) following repair of rhegmatogenous retinal detachments (RD) with proliferative vitreoretinopathy (PVR) undergoing retinectomy.
Interventional, retrospective, case-control study.
This single-institution study evaluated patients who underwent retinectomy during repair of RD with PVR from January 1, 2015 to December 31, 2019. A good VA cohort was identified based on a final VA ≥20/70. A 2:1 age-matched and gender-matched poor VA cohort with VA <20/70 was subsequently identified. Metrics compared between the two cohorts included time from primary and recurrent RD diagnosis to surgery, lens status, initial RD size, macula involvement, PVR grade, and size of retinectomy.
A total of 5355 eyes were diagnosed with primary RD during the study period, of which 345 had PVR and underwent retinectomy. The good VA cohort included 62 eyes with a mean final logMAR VA of 0.32 [Snellen 20/42], while the poor VA cohort included 119 eyes with a mean final logMAR VA of 1.54 [Snellen 20/693; P < .0001]. On multivariate analysis, smaller initial RD size (P = .0090), fewer surgeries (P = .0002), shorter time between recurrent RD diagnosis and subsequent surgeries (P = .0006), better preoperative VA (P = .0276), and pseudophakia at final visit (P = .0049) remained significant predictors of good vision.
Eyes undergoing retinectomy during repair of RD with PVR can achieve good VA outcomes. The primary modifiable factor associated with better VA was shorter delay between redetachment diagnosis and surgery, particularly in the absence of silicone oil tamponade.
研究增生性玻璃体视网膜病变（PVR）合并孔源性视网膜脱离（RD）行视网膜复位术后，与良好视力相关的因素。
介入性、回顾性、病例对照研究。
本单中心研究评估了 2015 年 1 月 1 日至 2019 年 12 月 31 日期间因 PVR 合并 RD 行视网膜复位术的患者。根据最终视力≥20/70 确定良好视力组。随后，按照年龄和性别 2:1 匹配，选择视力<20/70 的视力不良组。比较两组的指标包括：从初次 RD 诊断到手术的时间、晶状体状态、初次 RD 大小、黄斑受累、PVR 分级和视网膜切除的大小。
研究期间共有 5355 只眼诊断为原发性 RD，其中 345 只眼有 PVR 并接受了视网膜复位术。良好视力组包括 62 只眼，平均最终 logMAR 视力为 0.32（Snellen 20/42），而视力不良组包括 119 只眼，平均最终 logMAR 视力为 1.54（Snellen 20/693；P<.0001）。多变量分析显示，较小的初始 RD 大小（P=0.0090）、较少的手术次数（P=0.0002）、初次 RD 诊断至再次手术的时间较短（P=0.0006）、术前视力较好（P=0.0276）和最终随访时的后房型人工晶状体（P=0.0049）是视力良好的显著预测因素。
在修复合并 PVR 的 RD 时行视网膜复位术的眼睛可以获得良好的视力结果。与更好的视力相关的主要可调节因素是脱离诊断和手术之间的时间较短，尤其是在没有硅油填充的情况下。
