Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Veterans Health Service Medical Center, Seoul, Korea.
BMC Ophthalmol. 2022 Oct 7;22(1):399. doi: 10.1186/s12886-022-02614-5.
To compare the efficacy of intraoperative localized and 360-degree laser photocoagulation in 23-gauge limited pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).
This retrospective, comparative, consecutive, interventional study included 155 eyes of 155 patients who underwent primary repair of RRD utilizing 23-gauge PPV with at least six months of follow up. Medical records were retrospectively reviewed, and the corresponding demographic data, preoperative ophthalmic features, surgical management, and postoperative course were recorded. Main outcome measures included single surgery anatomical success, pre- and post-operative visual acuity, and complications.
Eighty-three patients (group A) received localized laser photocoagulation in PPV, while the remaining 72 patients (group B) received underwent circumferential 360-degree laser photocoagulation in PPV. Two skilled-surgeons performed all the surgeries, and 23-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and gas tamponade were used in each case. No significant difference was identified in baseline characteristics. The single surgery anatomical success rate was 96.4 % in group A, and 95.8 % in group B, showing no significant difference (p = 1.00). Primary anatomical failure was caused by re-detachment due to break in 2 eyes in each group (no new break 1 eye, new break 1eye in group A, 2 eyes with no new break in group B), and proliferative vitreoretinopathy in 1 eye in each group. Other complications were epiretinal membrane in 7 eyes (3 in group A, 4 in group B), and macular hole in 1 eye in group B. There were no differences in pre- and post-operative best-corrected visual acuity (BCVA) as well as BCVA improvement (p=0.144, p=0.866 and p=0.263, respectively).
Localized laser photocoagulation showed no difference in anatomic and visual outcome in RRD patients, when compared with 360-degree laser photocoagulation in limited PPV. Routine circumferential 360-degree laser photocoagulation may not be necessary in vitrectomy surgery for primary rhegmatogenous retinal detachment without severe PVR.
比较术中局部和 360 度激光光凝在 23 号auge 有限经睫状体平坦部玻璃体切割术（PPV）治疗孔源性视网膜脱离（RRD）中的疗效。
这是一项回顾性、对照、连续、干预性研究，纳入了 155 例 155 只眼的患者，这些患者均接受了 23 号auge PPV 治疗，且至少随访 6 个月。回顾性查阅病历，记录相应的人口统计学资料、术前眼部特征、手术管理和术后过程。主要观察指标包括单次手术解剖成功率、术前和术后视力以及并发症。
83 例患者（A 组）在 PPV 中接受局部激光光凝，而其余 72 例患者（B 组）在 PPV 中接受了 360 度环形激光光凝。两位熟练的外科医生均进行了所有手术，且每例手术均使用 23 号auge PPV 器械、广角观察系统、眼内激光光凝和气体填充。两组患者的基线特征无显著差异。A 组单次手术解剖成功率为 96.4%，B 组为 95.8%，差异无统计学意义（p=1.00）。原发性解剖失败的原因是两组各有 2 只眼因裂孔再脱离（A 组无新裂孔 1 只眼，新裂孔 1 只眼，B 组均无新裂孔 2 只眼），以及两组各有 1 只眼发生增殖性玻璃体视网膜病变。其他并发症包括 7 只眼（A 组 3 只眼，B 组 4 只眼）发生视网膜内膜，以及 B 组 1 只眼发生黄斑裂孔。术前和术后最佳矫正视力（BCVA）以及 BCVA 改善情况无差异（p=0.144，p=0.866，p=0.263）。
与 23 号auge 有限 PPV 中的 360 度激光光凝相比，局部激光光凝在 RRD 患者中的解剖和视力结果无差异。对于没有严重 PVR 的原发性孔源性视网膜脱离，玻璃体切割术中常规行 360 度环形激光光凝可能并非必要。
