Department of Ophthalmology, Sydney & Sydney Eye Hospital, Sydney, New South Wales, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Ophthalmol Retina. 2022 Nov;6(11):985-991. doi: 10.1016/j.oret.2022.05.025. Epub 2022 May 31.
To determine whether a difference exists between cryotherapy and endolaser photocoagulation retinopexy in terms of the rates of anatomic success after primary rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV).
Registry-based, nonrandomized, observational cohort study.
Eyes with primary RRD in a binational retinal surgery registry that underwent repair with PPV and had a minimum of 3 months of follow-up.
Cases were recorded prospectively by participating surgeons, and the outcomes were recorded at 3 months. A generalized mixed model approach was used to compare the effect of retinopexy type on the outcomes. Variables known to be associated with retinal surgical success were considered as covariates for the final model. The eyes were divided into 2 groups: Cryo group (receiving cryotherapy as the only form of retinopexy) and Laser group (receiving endolaser as the only form of retinopexy).
The primary endpoint was the proportion of patients with stable retinal reattachment without the need for further retinal detachment surgery, assessed 3 months after the surgery. Failure was defined as either retinal redetachment or foveal attachment with long-term silicone oil tamponade at the endpoint. The secondary outcome measured was visual acuity at 3 months compared with baseline measurements.
A total of 2413 patients were included, and the overall single-procedure success rate was 85%. There was no statistically significant difference in surgical success between the adjusted proportion of successful reattachment for the Cryo group (87%) and that of successful reattachment for the Laser group (82%) (P = 0.84; odds ratio, 1.04; 95% confidence interval, 0.74-1.46). There was no difference in the mean change in the visual outcomes at 3 months between the groups (adjusted mean change of -0.48 logarithm of the minimum angle of resolution [logMAR] for the Cryo group vs. -0.50 logMAR for the Laser group, P = 0.82).
The choice of cryotherapy versus endolaser retinopexy was observed to influence neither the anatomic success of PPV for RRD nor the visual acuity outcomes at 3 months after the surgery.
通过对比经睫状体平坦部玻璃体切除术（PPV）修复原发性孔源性视网膜脱离（RRD）后，冷冻治疗与眼内激光光凝视网膜光凝术在解剖学成功方面的差异，来确定冷冻治疗与眼内激光光凝视网膜光凝术在原发性 RRD 修复中的效果是否存在差异。
基于注册的、非随机的、观察性队列研究。
在一个跨国视网膜手术注册中心接受 PPV 修复且随访时间至少 3 个月的原发性 RRD 眼。
通过参与手术的外科医生进行前瞻性记录，在 3 个月时记录结果。采用广义混合模型方法比较两种视网膜光凝术类型对结果的影响。将已知与视网膜手术成功相关的变量作为最终模型的协变量。将这些眼分为两组：冷冻治疗组（仅接受冷冻治疗作为唯一的视网膜光凝术形式）和激光治疗组（仅接受眼内激光作为唯一的视网膜光凝术形式）。
主要终点是手术后 3 个月无进一步视网膜脱离手术且视网膜稳定复位的患者比例。失败定义为视网膜再脱离或在终点时伴有长期硅油填充的黄斑区贴附。次要观察指标是与基线测量相比，手术后 3 个月的视力。
共纳入 2413 例患者，单次手术成功率总体为 85%。调整后冷冻治疗组（87%）和激光治疗组（82%）的成功再附着比例在统计学上无显著差异（P=0.84；优势比，1.04；95%置信区间，0.74-1.46）。两组在术后 3 个月时的视力变化平均值之间无差异（冷冻治疗组调整后的平均变化为-0.48 最小角分辨率对数视力 [logMAR]，激光治疗组为-0.50 logMAR，P=0.82）。
冷冻治疗与眼内激光光凝视网膜光凝术的选择既不会影响 RRD 的 PPV 解剖学成功率，也不会影响术后 3 个月的视力结果。
