360 激光阻挡对白内障术后视网膜脱离手术结果的影响；曼彻斯特白内障术后视网膜脱离研究。
The impact of 360-laser barricade on outcomes of vitrectomy for pseudophakic retinal detachment; The Manchester Pseudophakic Retinal Detachment Study.
机构信息
Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK.
The Hashemite University, P.O. Box 330127, Zarqa, 13133, Jordan.
出版信息
Eye (Lond). 2023 Oct;37(15):3221-3227. doi: 10.1038/s41433-023-02495-y. Epub 2023 Mar 22.
PURPOSE
To investigate the anatomical and functional outcomes and specifically, the effect of 360-degree barrier-laser, in pars plana vitrectomy (PPV) for primary pseudophakic rhegmatogenous retinal detachment (PRD).
METHODS
We conducted a single-centre retrospective, continuous and comparative study on eyes that had undergone PPV with focal-retinopexy (laser or cryotherapy) versus 360-laser for PRD repair between 2011-2020 at a single tertiary vitreoretinal centre in the UK. Primary outcomes were single surgery anatomical success (SSAS) rate and final postoperative visual acuity (VA). Multivariable regression covariates for primary re-detachment included age, gender, onset-of-detachment, pre-operative VA, ocular co-morbidities, macula-status, majority inferior (vs superior) PRD, number-of-tears and PRD extent (in clock-hours), 360-laser barricade, and perfluorocarbon liquid (PFCL) use. For VA gain, primary re-detachment was added as a covariate.
RESULTS
We included 467 eyes with a mean follow-up of 388 (161) days. The SSAS was 444/467 (95.1%) overall, and 351/370 (94.9%) and 93/97 (95.9%) in focal-retinopexy and 360-laser groups, respectively (p = 0.798). Compared to the focal-retinopexy group, the 360-laser group had significantly worse post-operative VA but similar logMAR gain (p = 0.812). A multivariable binary logistic regression found that only PFCL use was linked with increased primary re-detachment (OR:5.32 [p = 0.048]) and 360-laser did not contribute to increased SSAS. A multivariable linear regression analysis showed that poor logMAR gain was significantly associated with better pre-operative logMAR, ocular co-morbidities, greater PRD extent, use of 360-laser and primary re-detachment. However, when excluding macula-off RD (n = 211), 360-laser was no longer significant (p = 0.088).
CONCLUSIONS
Prophylactic 360-laser does not seem to impact on SSAS and functional outcomes following PPV for primary PRD.
目的
研究 360 度屏障激光在原发性白内障继发孔源性视网膜脱离（RRD）的平面内玻璃体切除术中的解剖和功能结果，特别是 360 度屏障激光的效果。
方法
我们在英国的一家单一的三级玻璃体视网膜中心进行了一项单中心回顾性、连续性和比较性研究，比较了 2011 年至 2020 年间接受平面内玻璃体切除联合局部视网膜光凝（激光或冷冻）与 360 度激光治疗原发性 RRD 的患者。主要结局为单次手术解剖成功率（SSAS）和最终术后视力（VA）。主要再脱离的多变量回归协变量包括年龄、性别、脱离开始时间、术前 VA、眼部合并症、黄斑状态、大多数下方（vs 上方）RRD、撕裂数量和 RRD 范围（时钟小时）、360 度激光屏障和全氟碳液体（PFCL）的使用。对于 VA 获益，将主要再脱离作为协变量添加。
结果
我们纳入了 467 只眼，平均随访 388（161）天。SSAS 总体为 444/467（95.1%），局部视网膜光凝组为 351/370（94.9%）和 93/97（95.9%），360 度激光组为 444/467（95.1%）（p=0.798）。与局部视网膜光凝组相比，360 度激光组术后视力明显较差，但对数视力增益相似（p=0.812）。多变量二项逻辑回归发现，只有 PFCL 的使用与原发性再脱离增加相关（OR：5.32 [p=0.048]），而 360 度激光并没有增加 SSAS。多变量线性回归分析表明，较差的对数视力增益与更好的术前对数视力、眼部合并症、更大的 RRD 范围、360 度激光和原发性再脱离显著相关。然而，当排除黄斑脱离 RD（n=211）时，360 度激光不再具有统计学意义（p=0.088）。
结论
在原发性 RRD 的平面内玻璃体切除术后，预防性 360 度激光似乎不会影响 SSAS 和功能结局。
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