Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Eye (Lond). 2023 Mar;37(4):684-691. doi: 10.1038/s41433-022-02028-z. Epub 2022 Mar 25.
To investigate practice patterns and clinical outcomes in the repair of uncomplicated rhegmatogenous retinal detachments (RRD) in a real-world setting over a 10-year period.
We compared preferences for scleral buckling (SB), pars plana vitrectomy (PPV), PPV/SB, or pneumatic retinopexy (PR) over time, and examined the 1-year single surgery anatomic success (SSAS) and best-corrected visual acuity (BCVA) at a tertiary academic institution from 2008-2018.
Eight hundred eight eyes had RRD repair between 2008-2011 (n = 240), 2012-2014 (n = 271), and 2015-2017 (n = 297). Compared to 2008-2011, PPV was preferred over SB in 2012-2014 (OR: 2.93; 95% CI: 1.86-4.63) and 2015-2017 (OR: 5.94; 95% CI: 3.76-9.38), and over PPV/SB in 2012-2014 (OR: 2.74; 95% CI: 1.65-4.56) and 2015-2017 (OR: 3.16; 95% CI: 31.96-5.12). PR was uncommonly utilized (<10%). Younger surgeons (graduating 2010-2017) favored PPV over SB when compared to older surgeons [graduating 1984-2000 (OR: 1.77; 95% CI: 1.18-2.65) and 2001-2009 (OR 1.73; 95% CI: 1.14-2.65)], but similarly selected PPV vs. PPV/SB as their older counterparts (p > 0.05). Compared to PPV, SSAS was higher with SB (OR: 1.53; 95% CI: 1.03-2.26) and PPV/SB (OR: 2.55; 95% CI: 1.56-4.17). One-year BCVA was markedly improved compared to baseline only for eyes that achieved SSAS (p < 0.001).
Over the past 10 years, PPV has become the favored approach to repair uncomplicated RRD and this appears to be driven by younger surgeons' preferences. Given the superior long-term SSAS in SB and PPV/SB as compared to PPV, SB and PPV/SB should be more frequently considered when determining the appropriate repair strategy for uncomplicated RRD.
在过去十年中，研究在真实环境中修复单纯孔源性视网膜脱离（RRD）的实践模式和临床结果。
我们比较了巩膜扣带术（SB）、经睫状体平坦部玻璃体切除术（PPV）、PPV/SB 和充气性视网膜固定术（PR）随时间的偏好，并在 2008-2018 年在一家三级学术机构检查了单手术 1 年解剖成功率（SSAS）和最佳矫正视力（BCVA）。
2008-2011 年（n=240）、2012-2014 年（n=271）和 2015-2017 年（n=297）间共有 808 只眼接受 RRD 修复。与 2008-2011 年相比，2012-2014 年（OR：2.93；95%CI：1.86-4.63）和 2015-2017 年（OR：5.94；95%CI：3.76-9.38）PPV 较 SB 更受欢迎，2012-2014 年（OR：2.74；95%CI：1.65-4.56）和 2015-2017 年（OR：3.16；95%CI：31.96-5.12）PPV 较 PPV/SB 更受欢迎。PR 很少使用（<10%）。与老年医生（1984-2000 年毕业，OR：1.77；95%CI：1.18-2.65；2001-2009 年毕业，OR：1.73；95%CI：1.14-2.65）相比，年轻医生（2010-2017 年毕业，OR：1.77；95%CI：1.18-2.65）更倾向于选择 PPV 而不是 SB，但与老年医生选择 PPV 与 PPV/SB 作为他们的选择相同（p>0.05）。与 PPV 相比，SB（OR：1.53；95%CI：1.03-2.26）和 PPV/SB（OR：2.55；95%CI：1.56-4.17）的 SSAS 更高。只有在达到 SSAS 的情况下，1 年 BCVA 才会明显优于基线（p<0.001）。
在过去的 10 年中，PPV 已成为修复单纯 RRD 的首选方法，这似乎是由年轻医生的偏好所驱动。鉴于 SB 和 PPV/SB 在长期 SSAS 方面优于 PPV，因此在确定单纯 RRD 的适当修复策略时，应更频繁地考虑 SB 和 PPV/SB。
