Zhou Chuandi, Gu Chufeng, Li Bo, Wang Yujie, Hu Yanan, She Xinping, Shi Ya, Ma Mingming, Sun Tao, Qiu Qinghua, Fan Ying, Chen Fenge, Wang Hong, Liu Kun, Sun Xiaodong, Xu Xun, Zheng Zhi
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai, China.
National Clinical Research Center for Eye Diseases, No. 100 Haining Road, Hongkou District, Shanghai, China.
Eye Vis (Lond). 2023 Feb 3;10(1):9. doi: 10.1186/s40662-022-00325-y.
To investigate the prevalence and predictors of retinal breaks reopening after vitrectomy with air tamponade in rhegmatogenous retinal detachment (RRD).
A retrospective cohort study was conducted in Shanghai General Hospital. Chart review was performed among 1715 patients with primary RRD who received pars plana vitrectomy (PPV) with air tamponade as initial management. Patients were followed up for recurrence. The clinical features of the eyes with retinal breaks reopening were recorded. Logistic regression was constructed to investigate the predictors for breaks reopening.
A total of 137 (7.99%) patients had recurrent retinal detachment after PPV with air tamponade. The causes of surgery failure included new or missed retinal breaks (48.9%), reopening of original tears (43.8%) and proliferative vitreoretinopathy (7.3%). The median time to recurrence for the patients with breaks reopening was 18.0 days. Multivariate logistic regression indicated that the presence of retinal break(s) ≥ 1.5 disc diameters (DD) (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 11.04-6.92, P = 0.041), and shorter period for restricted activities (OR: 0.94, 95% CI: 0.89-0.99, P = 0.020) were the independent predictors for breaks reopening.
Breaks reopening is an important cause for retinal redetachment after PPV with air tamponade in primary RRD. The first 2-4 weeks after surgery is the "risk period" for breaks reopening. Special attention should be paid for patients with retinal break(s) ≥ 1.5 DD. A prolonged period for restricted activities is recommended.
探讨孔源性视网膜脱离（RRD）行玻璃体切除联合空气填充术后视网膜裂孔重新开放的发生率及预测因素。
在上海交通大学医学院附属新华医院进行一项回顾性队列研究。对1715例接受玻璃体切除联合空气填充术作为初始治疗的原发性RRD患者进行病历回顾。对患者进行复发随访。记录视网膜裂孔重新开放患者的临床特征。构建逻辑回归模型以研究裂孔重新开放的预测因素。
共有137例（7.99%）患者在玻璃体切除联合空气填充术后发生复发性视网膜脱离。手术失败的原因包括新的或遗漏的视网膜裂孔（48.9%）、原裂孔重新开放（43.8%）和增生性玻璃体视网膜病变（7.3%）。裂孔重新开放患者的复发中位时间为18.0天。多因素逻辑回归分析表明，存在直径≥1.5个视盘直径（DD）的视网膜裂孔（比值比[OR]：2.68，95%置信区间[CI]：11.04 - 6.92，P = 0.041）以及活动受限时间较短（OR：0.94，95% CI：0.89 - 0.99，P = 0.020）是裂孔重新开放的独立预测因素。
裂孔重新开放是原发性RRD玻璃体切除联合空气填充术后视网膜再脱离的重要原因。术后最初2 - 4周是裂孔重新开放的“危险期”。对于存在直径≥1.5 DD视网膜裂孔的患者应特别关注。建议延长活动受限时间。
