Ahmad Tessnim R, Bever Gregory J, Stewart Jay M
Department of Ophthalmology, University of California, San Francisco, CA 94158, USA.
Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA 94110, USA.
Life (Basel). 2023 Jan 19;13(2):284. doi: 10.3390/life13020284.
In this retrospective comparative case series at a teaching hospital, we reviewed adult patients with rhegmatogenous retinal detachment who underwent scleral buckling surgery with external drainage of subretinal fluid performed before versus after placement of the scleral buckle. Eight eyes in each group were roughly matched for age, sex, baseline visual acuity (VA), and detachment characteristics. The complication rate was 0% for the "before" group and 37% for the "after" group ( = 0.100). In the "after" group, two eyes (25%) developed iatrogenic retinal holes and one eye (12%) developed self-limited subretinal hemorrhage during external needle drainage. The duration of surgery was significantly shorter for the "before" group (mean 89 ± 16 min) compared to the "after" group (118 ± 20 min) ( = 0.008). The primary anatomic success rate was 100% for the "before" group and 75% for the "after" group ( = 0.233). Final VA was not significantly different between the groups or from baseline. In conclusion, while limited by our small sample size, this pilot study suggests that drainage of subretinal fluid before scleral buckle placement may be safer and more efficient compared to draining after buckle placement. Initial drainage may facilitate retinochoroid apposition to allow targeted cryopexy and precise buckle placement.
在这家教学医院进行的这项回顾性比较病例系列研究中，我们回顾了接受巩膜扣带术及视网膜下液外引流的孔源性视网膜脱离成年患者，比较了在放置巩膜扣带之前与之后进行该手术的情况。每组8只眼睛在年龄、性别、基线视力（VA）和脱离特征方面大致匹配。“术前”组的并发症发生率为0%，“术后”组为37%（P = 0.100）。在“术后”组中，2只眼睛（25%）在外部针吸引流期间出现医源性视网膜裂孔，1只眼睛（12%）出现自限性视网膜下出血。“术前”组的手术时间（平均89±16分钟）明显短于“术后”组（118±20分钟）（P = 0.008）。“术前”组的主要解剖成功率为100%，“术后”组为75%（P = 0.233）。两组之间的最终视力与基线相比无显著差异。总之，尽管受样本量小的限制，但这项初步研究表明，与在放置巩膜扣带之后引流相比，在放置之前引流视网膜下液可能更安全、更有效。初始引流可能有助于视网膜脉络膜贴附，以便进行有针对性的冷冻治疗和精确的扣带放置。
