Yannuzzi Nicolas A, Brown Karen, Callaway Natalia F, Patel Nimesh A, Albini Thomas A, Berrocal Audina M, Davis Janet L, Gregori Ninel N, Fortun Jorge, Haddock Luis J, Lee Wen-Hsiang, Schwartz Stephen G, Sridhar Jayanth, Smiddy William E, Flynn Harry W, Townsend Justin
Department of Ophthalmology, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
J Vitreoretin Dis. 2019 Dec 20;4(2):91-95. doi: 10.1177/2474126419893816. eCollection 2020 Mar-Apr.
This article reports the influence of timing on the clinical outcomes in primary extramacular rhegmatogenous retinal detachment (RRD) at a tertiary referral center.
A retrospective case series was conducted of all patients presenting between January 1, 2014 and December 31, 2016, with primary extramacular RRD. Retinal detachments with grade C proliferative vitreoretinopathy, combined tractional and RRD, eyes with inflammatory disease, and prior retinal surgery were excluded. The main outcome measures were single-operation anatomic success (SOAS), final anatomic success, and best-corrected visual acuity (BCVA).
There were 202 eyes of 198 patients with an average of 22 months' follow-up (range, 6-47 months). Eyes were operated on an average of 1.1 days after initial presentation. At last clinical examination, SOAS had been achieved in 174 (86%) eyes, final anatomic success in 200 (99%) eyes, and average postoperative logarithm of the minimum angle of resolution (logMAR) BCVA was 0.18 (Snellen equivalent, 20/30; SD, 0.36). In those treated the day of presentation, average postoperative logMAR BCVA was 0.18 (Snellen, 20/31) in comparison to 0.18 (Snellen, 20/30) in those treated the day after presentation and 0.14 (Snellen, 20/28) in those treated after 2 days or more ( = .92).
Regarding timing of surgery, SOAS and BCVA outcomes in primary extramacular RRDs were favorable with an urgent and semiurgent approach to repair. There was no difference in visual and anatomic outcomes between patients who were operated on the day of presentation and those treated a short time later when clinical decisions were made by the treating surgeon on a case-by-case basis.
本文报告了在一家三级转诊中心，手术时机对原发性黄斑外孔源性视网膜脱离（RRD）临床结局的影响。
对2014年1月1日至2016年12月31日期间就诊的所有原发性黄斑外RRD患者进行回顾性病例系列研究。排除C级增殖性玻璃体视网膜病变、牵引性和RRD合并、有炎症性疾病的眼以及既往有视网膜手术史的视网膜脱离。主要结局指标为单次手术解剖成功（SOAS）、最终解剖成功以及最佳矫正视力（BCVA）。
198例患者的202只眼，平均随访22个月（范围6 - 47个月）。初次就诊后平均1.1天进行手术。在最后一次临床检查时，174只眼（86%）实现了SOAS，200只眼（99%）实现了最终解剖成功，术后平均最小分辨角对数（logMAR）BCVA为0.18（Snellen视力相当于20/30；标准差，0.36）。就诊当天接受治疗的患者，术后平均logMAR BCVA为0.18（Snellen，20/31），就诊后第二天接受治疗的患者为0.18（Snellen，20/30），就诊后2天或更长时间接受治疗的患者为0.14（Snellen，20/28）（P = 0.92）。
关于手术时机，原发性黄斑外RRD采用紧急和半紧急修复方法时，SOAS和BCVA结局良好。就诊当天接受手术的患者与稍后接受治疗的患者在视觉和解剖结局上没有差异，具体治疗由外科医生根据具体病例情况做出临床决策。
