Alexandria University, Alexandria, Egypt.
BMC Ophthalmol. 2022 May 20;22(1):227. doi: 10.1186/s12886-022-02449-0.
To compare the safety and efficacy of Ab-externo subretinal bands removal in comparison with the classical Ab-interno approach during pars plana vitrectomy for primary rhegmatogenous retinal detachment.
Subjects aged 28-62 years with primary RRD complicated by proliferative vitreoretinopathy (PVR) with subretinal bands interfering with retinal flattening were treated by pars plana vitrectomy (PPV) and silicone oil injection. Subretinal bands were removed using the classical AB interno approach through one or more retinotomies in ten patients (group A) and using AB externo approach in twenty cases (group B). Post-operative follow-up visits occurred at 1 day, 1 week, 1 month, and 3 months, after surgery. The main outcomes were assessment of subretinal bands removal efficacy, documentation of complications, anatomical reattachment rate, and postoperative best-corrected visual acuity (BCVA).
There was no statistically significant difference between both groups regarding patients' age, gender, lens status, and the onset of retinal detachment. Seventy percent of both groups presented with inferior retinal detachment while ten percent presented with temporal detachments and twenty percent had a total retinal detachment. Both groups had a statistically significant improvement in postoperative visual acuity in comparison with preoperative visual acuity (P = 0.005 for group A and P = < 0.001 for group B). There was no statistically significant difference between both groups regarding preoperative (P = 0.928) and postoperative (P = 0.185) visual acuity. A higher incidence of complications was reported in group A (40%) in comparison with group B (30%) but this difference was not statistically significant (P = 0.69). More Epimacular membranes were seen postoperatively in group A (30%) in comparison with group B (20%) but again this difference was not statistically significant (P = 0.657). Subretinal hemorrhage was seen in ten percent of cases in both groups. Intraocular pressure was measured in every follow-up of all patients in both groups, no statistically significant difference was found between both groups.
Both techniques are effective and safe to remove subretinal bands with similar outcomes.
比较经睫状体平坦部玻璃体切割术（PPV）联合硅油眼内填充治疗原发性孔源性视网膜脱离（RRD）合并增殖性玻璃体视网膜病变（PVR）时，应用巩膜外视网膜带切除术与经典经内路巩膜扣带术治疗的安全性和有效性。
选择 28-62 岁原发性 RRD 合并增殖性玻璃体视网膜病变（PVR）伴视网膜下带影响视网膜平复的患者，行 PPV 联合硅油眼内填充。通过一个或多个视膜切开术应用经典巩膜内路（A 组 10 例）和巩膜外路（B 组 20 例）去除视网膜下带。术后 1 天、1 周、1 个月和 3 个月进行随访。主要观察指标为视网膜下带去除效果、并发症、解剖复位率和术后最佳矫正视力（BCVA）。
两组患者的年龄、性别、晶状体状态和视网膜脱离发病时间差异无统计学意义。两组视网膜脱离均以下方多见（70%），颞侧（10%）和全视网膜脱离（20%）。两组术后视力均较术前显著提高（A 组 P=0.005，B 组 P<0.001）。两组术前（P=0.928）和术后（P=0.185）视力差异均无统计学意义。A 组并发症发生率（40%）高于 B 组（30%），但差异无统计学意义（P=0.69）。A 组术后发现更多的黄斑前膜（30%），B 组为 20%，但差异无统计学意义（P=0.657）。两组均有 10%的病例出现视网膜下出血。两组均在每次随访中测量眼压，差异无统计学意义。
巩膜外视网膜带切除术和经典巩膜扣带术均可有效、安全地去除视网膜下带，且效果相似。
