Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
VitreoRetinal Surgery in Minneapolis, Minneapolis, Minnesota.
Ophthalmol Retina. 2023 Sep;7(9):788-793. doi: 10.1016/j.oret.2023.05.012. Epub 2023 May 20.
To assess the risk of retinal displacement after scleral buckle (SB) versus pars plana vitrectomy with SB (PPV-SB).
Multicenter prospective nonrandomized clinical trial.
The study took place at VitreoRetinal Surgery in Minneapolis, Minnesota, Sankara Nethralaya in Chennai, India, and St. Michael's Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment with gradable postoperative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3 months postoperatively. Metamorphopsia and aniseikonia were assessed with M-CHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings on FAF in SB versus PPV-SB.
Ninety-one eyes were included in this study, of which 46.2% (42 of 91) had SB and 53.8% (49 of 91) underwent PPV-SB. Three months postoperatively, 16.7% (7 of 42) in the SB group and 38.8% (19 of 49) in the PPV-SB group had evidence of retinal displacement (difference = 22.1%; odds ratio = 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logarithm of the minimum angle of resolution, lens status, and sex in a multivariate regression analysis (P = 0.01). Retinal displacement was detected in 22.5% (6 of 27) of patients in the SB group with external subretinal fluid drainage and 6.7% (1 of 15) of patients without external drainage (difference = 15.8%; odds ratio = 4.0; 95% CI, 0.4-36.9; P = 0.19). Mean vertical metamorphopsia, horizontal metamorphopsia (MH), and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse MH in patients with retinal displacement versus those without retinal displacement (P = 0.067).
Scleral buckle is associated with less retinal displacement compared with PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend toward increased risk of retinal displacement in SB eyes that underwent external drainage compared with SB eyes without drainage, which is consistent with our understanding that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse MH at 3 months in patients with retinal displacement.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估巩膜扣带术（SB）与巩膜扣带联合玻璃体切除术（PPV-SB）后视网膜移位的风险。
多中心前瞻性非随机临床试验。
该研究于 2019 年 7 月至 2022 年 2 月在明尼苏达州明尼阿波利斯的 VitreoRetinal Surgery、印度钦奈的 Sankara Nethralaya 和加拿大多伦多的圣迈克尔医院进行。纳入了接受巩膜扣带或巩膜扣带联合玻璃体切除术治疗累及黄斑的孔源性视网膜脱离且术后眼底自发荧光（FAF）成像可分级的患者。两名盲法评估者在术后 3 个月评估 FAF 图像。使用 M-CHART 和新的不等像测试分别评估形觉扭曲和不等像。主要结局是在 FAF 上通过视网膜血管印片检测到巩膜扣带术与巩膜扣带联合玻璃体切除术组中视网膜移位的患者比例。
本研究纳入了 91 只眼，其中 46.2%（42/91）行巩膜扣带术，53.8%（49/91）行巩膜扣带联合玻璃体切除术。术后 3 个月，巩膜扣带组中有 16.7%（7/42），巩膜扣带联合玻璃体切除术组中有 38.8%（19/49）出现视网膜移位（差异=22.1%；比值比=3.2；95%置信区间[CI]，1.2-8.6；P=0.02）。多变量回归分析调整视网膜脱离范围、基线最小分辨角对数、晶状体状态和性别后，这种关联的统计学意义增加（P=0.01）。在巩膜扣带组中，有外部视网膜下液引流的患者中 22.5%（6/27）和无外部引流的患者中 6.7%（1/15）（差异=15.8%；比值比=4.0；95%CI，0.4-36.9；P=0.19）检测到视网膜移位。巩膜扣带组和巩膜扣带联合玻璃体切除术组患者的垂直形觉扭曲、水平形觉扭曲（MH）和不等像均相似。与无视网膜移位的患者相比，有视网膜移位的患者 MH 更差（P=0.067）。
与巩膜扣带联合玻璃体切除术相比，巩膜扣带术与较少的视网膜移位相关，这表明传统的玻璃体切除术技术会导致视网膜移位。与无引流的巩膜扣带术眼相比，接受外部引流的巩膜扣带术眼发生视网膜移位的风险增加，这与我们的理解一致，即 SB 术中发生的视网膜下液的医源性运动，如在外部引流过程中，可能会导致视网膜拉伸和移位，如果随后将视网膜固定在拉伸位置。与无视网膜移位的患者相比，有视网膜移位的患者在术后 3 个月时 MH 更差。
作者没有与本文讨论的任何材料有关的专有或商业利益。
