慢性黄斑脱离性视网膜脱离修复的结果。
Outcomes of chronic macula-off retinal detachment repair.
机构信息
Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.
Denver and Health Sciences Center, University of Colorado, Denver, CO, USA.
出版信息
Graefes Arch Clin Exp Ophthalmol. 2023 Mar;261(3):709-714. doi: 10.1007/s00417-022-05876-3. Epub 2022 Oct 27.
PURPOSE
There have been disparate outcomes in the few studies that have looked at anatomic success and visual acuity (VA) in chronic retinal rhegmatogenous detachment (RRD) repair. Chronic retinal detachments (RD) without a posterior vitreous detachment (PVD) occur in young myopes often secondary to an atrophic hole. These patients are often asymptomatic, and studies report good surgical anatomic results. However, chronic RD with a PVD is symptomatic but presents late due to patient compliance. This paper aims to evaluate this lesser-studied chronic macula-off RD with PVD.
METHODS
After obtaining Institutional Review Board (IRB) approval, patients who had undergone surgical intervention for all diagnosis codes of RD were identified in the Denver Health Medical Center database. Medical records were reviewed, and patients found to have open-globe injuries, tractional RD due to proliferative diabetic retinopathy, macula-on detachments, and RD due to previous ocular surgery were excluded. Similarly, patients without PVD were also excluded. A total of 37 patients with PVD-type chronic macula-off RD were thus identified and preoperative characteristics, surgical intervention, and complications were analyzed.
RESULTS
The average patient age was 53.8 years. The length of RRD duration ranged from 30 to 365 days (mean 136.7 days). Twenty-six (70.3% patients had proliferative vitreoretinopathy (PVR) grade C or greater. Initial anatomic success-defined as re-attachment after one surgery-was 54.1%. The final attachment was 94.6%. Fifteen of 37 (40.5%) of the patients had issues with drop adherence, positioning, or missing post-operative appointments.
CONCLUSION
Chronic macula-off RD with a PVD should be identified as it is associated with much lower rates of initial re-attachment. Socioeconomic factors likely are the driving factor for patients with PVD-type chronic macula-off RD to present late, struggle with positioning, and have difficulty with follow-up and drop compliance. These extended periods without treatment then lead to high rates of PVR and poor initial anatomic success. However, repair of PVD-type chronic macula-off RD should still be pursued as final anatomic success is high.
目的
少数研究着眼于解剖学成功和视力（VA）在慢性视网膜裂孔性脱离（RRD）修复中的结果存在差异。无后玻璃体脱离（PVD）的慢性视网膜脱离（RD）常发生于年轻的近视患者，通常继发于萎缩性孔。这些患者通常无症状，研究报告手术解剖学结果良好。然而，有 PVD 的慢性 RD 是有症状的，但由于患者依从性差而晚期出现。本文旨在评估这种研究较少的慢性黄斑下 RD 合并 PVD。
方法
在获得机构审查委员会（IRB）批准后，在丹佛健康医疗中心数据库中确定了所有 RRD 诊断代码接受手术干预的患者。回顾病历，排除开放性眼外伤、增生性糖尿病视网膜病变引起的牵拉性 RD、黄斑下脱离以及以前眼手术引起的 RD 患者。同样，也排除了没有 PVD 的患者。因此，共确定了 37 例 PVD 型慢性黄斑下 RD 患者，并分析了术前特征、手术干预和并发症。
结果
患者平均年龄为 53.8 岁。RRD 持续时间从 30 到 365 天不等（平均 136.7 天）。26 例（70.3%）患者有增生性玻璃体视网膜病变（PVR）C 级或更高级别。初次解剖成功定义为一次手术后再附着，成功率为 54.1%。最终附着率为 94.6%。37 例患者中有 15 例（40.5%）存在滴眼剂依从性、定位或术后随访缺失问题。
结论
应识别合并 PVD 的慢性黄斑下 RD，因为其初始再附着率较低。社会经济因素可能是 PVD 型慢性黄斑下 RD 患者就诊较晚、定位困难以及难以随访和滴眼剂依从性差的驱动因素。这些无治疗的延长时间导致 PVR 发生率高和初始解剖学成功率低。然而，仍应尝试修复 PVD 型慢性黄斑下 RD，因为最终解剖学成功率较高。
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