Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Retin Cases Brief Rep. 2024 Sep 1;18(5):628-632. doi: 10.1097/ICB.0000000000001461.
The purpose of this study was to highlight a potential alternative to additional surgery for management of retinal redetachment through the use of additional facedown positioning with silicone oil tamponade.
Retrospective case series of two patients evaluated with examination, multimodal imaging, including fundus photography, optical coherence tomography, and fluorescein angiography.
In Case 1, a 70-year-old female patient underwent surgery for a full-thickness macular hole with associated macula-off retinal detachment, but experienced a recurrent detachment and underwent a second surgery with silicone oil placement. Another recurrent detachment was found. The case was managed conservatively with facedown positioning, resulting in resolution of subretinal fluid and improvement in vision. At follow-up, the retina remained attached with stable vision. In Case 2, a 25-year-old male patient underwent a surgical repair for proliferative vitreoretinopathy retinal detachment with a scleral buckle, cryotherapy, and external drainage. After multiple redetachment surgeries with retinectomy and oil placement, another tractional redetachment of the fovea was noted. Management was with facedown positioning, and follow-up evaluation showed resolution of the subretinal fluid and improvement in vision with stability for greater than 2 months.
For recurrent retinal redetachments with silicone oil in place, an additional week of facedown positioning can result in anatomical success and be a viable alternative or bridge to invasive surgical interventions. This approach may have greatest utility for patients who are poor surgical candidates without new peripheral pathology.
本研究旨在强调一种潜在的替代方法，即在硅油填充的情况下，通过增加俯卧位来治疗视网膜再脱离，以避免进一步手术。
回顾性分析了 2 例接受检查、多模态成像（包括眼底照相、光学相干断层扫描和荧光素血管造影）评估的患者。
在病例 1 中，一名 70 岁女性患者因全层黄斑裂孔伴黄斑脱离性视网膜脱离接受了手术，但出现了复发性脱离，并接受了第二次手术，包括硅油填充。随后又发现了一次复发性脱离。该病例采用保守治疗，即俯卧位，结果视网膜下液消退，视力改善。随访时，视网膜仍保持在位，视力稳定。在病例 2 中，一名 25 岁男性患者因增殖性玻璃体视网膜病变伴巩膜扣带、冷冻治疗和外部引流而接受了手术修复。在进行了多次视网膜脱离复位手术，包括视网膜切除术和硅油填充后，发现黄斑区再次出现牵引性脱离。采用俯卧位治疗，随访评估显示视网膜下液消退，视力改善，且稳定超过 2 个月。
对于硅油在位的复发性视网膜脱离，增加一周的俯卧位可能会导致解剖学上的成功，是一种可行的替代方法或桥梁，可避免侵入性手术干预。对于那些没有新的周边病变但手术条件差的患者，这种方法可能最有用。
