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两切口式干性玻璃体切割术治疗孔源性视网膜脱离:一项初步研究。

Two-port dry vitrectomy for rhegmatogenous retinal detachment: a pilot study.

机构信息

Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.

Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Rome, Italy.

出版信息

Eye (Lond). 2023 Dec;37(18):3801-3806. doi: 10.1038/s41433-023-02617-6. Epub 2023 Jun 10.

Abstract

OBJECTIVE

To evaluate the safety and efficacy of a new surgical technique for the management of primary rhegmatogenous retinal detachment (RRD), consisting of localized PPV near the retinal break(s), without infusion line, associated with a drainage of subretinal fluid and cryoretinopexy.

METHODS

Multicentric prospective study conducted at the University Hospital of Cagliari and IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma. Twenty eyes affected by RRD with the causative retinal break(s) in the superior meridians were enrolled between February 2022 and June 2022. Patients with cataract ≥3, aphakia, significant posterior capsule opacification, giant retinal tears, retinal dialysis, history of trauma and PVR ≥C2 were excluded. All eyes underwent a two-port 25-gauge PPV with localized removal of the vitreous surrounding retinal break(s), followed by 20% SF6 injection and cryopexy. The surgical time was recorded for each procedure. Best-corrected visual acuity (BCVA) was measured at baseline and postoperative 6 months.

RESULTS

Primary anatomic success at 6 months was achieved by 85% of patients. No complications occurred, except for three (15%) retinal re-detachments. The average surgical time was 8.61 ± 2.16 min. Overall, the difference between pre- and last postoperative mean BCVA was statistically significant (p = 0.02).

CONCLUSIONS

Two-port dry PPV demonstrated safety and efficacy for the treatment of RRD, reaching an 85% of anatomical success rate. Although further studies are necessary to confirm the efficacy and long-term benefit of this treatment, we believe that this surgical technique could be considered a valid and safe alternative for the management of primary RRD.

摘要

目的

评估一种新的原发性孔源性视网膜脱离(RRD)治疗手术技术的安全性和有效性,该技术包括在视网膜裂孔附近进行局部性经皮玻璃体切除术(PPV),不使用灌注管,联合视网膜下液引流和冷冻视网膜光凝术。

方法

这是一项在卡利亚里大学医院和罗马IRCCS Fondazione Policlinico Universitario A. Gemelli 进行的多中心前瞻性研究。2022 年 2 月至 2022 年 6 月期间,共纳入了 20 只累及优势子午线的 RRD 眼,这些眼均存在导致视网膜脱离的裂孔。排除白内障≥3 级、无晶状体、明显后囊混浊、巨大视网膜裂孔、视网膜裂孔、创伤史和 PVR≥C2 的患者。所有眼均接受了两切口 25G PPV 治疗,局部切除视网膜裂孔周围的玻璃体,随后注入 20%SF6 并进行冷冻视网膜光凝术。记录了每一步骤的手术时间。在基线和术后 6 个月时测量最佳矫正视力(BCVA)。

结果

85%的患者在术后 6 个月时达到了主要解剖学成功。除了 3 例(15%)视网膜再脱离外,无其他并发症发生。平均手术时间为 8.61±2.16 分钟。总体而言,术前和末次术后平均 BCVA 之间的差异具有统计学意义(p=0.02)。

结论

两切口干燥性 PPV 治疗 RRD 安全有效,达到了 85%的解剖学成功率。尽管还需要进一步的研究来证实这种治疗的疗效和长期益处,但我们认为这种手术技术可以被视为治疗原发性 RRD 的一种有效且安全的替代方法。

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