Grassi Piergiacomo, Charteris David
School of Medical Sciences, the University of Manchester, Manchester, UK.
Vitreoretinal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Clin Exp Optom. 2024 May;107(4):434-441. doi: 10.1080/08164622.2023.2236098. Epub 2023 Sep 6.
Primary retinectomy in eyes not previously vitrectomized has been previously rarely performed in a minority of cases, unlike non-primary retinectomies in vitrectomized eyes.
This paper aims to determine anatomical and functional outcomes of primary retinectomy, and to assess structural macular changes among successful cases.
In this retrospective multicentre cohort-study, 35 primary retinectomies in eyes undergoing initial vitrectomy for rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy C or D between 2014 and 2021 were included. The mean follow-up duration was 48 ± 59.24 months among successes and 46.54 ± 20.99 months among unsuccesses (p = 0.483).
The anatomical success rate was 48.5% after one retinectomy and 60% after two retinectomies. Mean postoperative best corrected visual acuity (BCVA) was 1.85 ± 0.62 logMAR (6/425 Snellen equivalent). The difference from mean preoperative BCVA was not significant (p = 0.312). Final BCVA ≥ 6/60 was achieved in 17% of cases, and no cases gained ≥6/24. Final mean postoperative BCVA of successes was 1.69 ± 0.60 logMAR (6/294 Snellen equivalent) compared with 2.10 ± 0.57 logMAR (6/756 Snellen equivalent) of unsuccessful cases (p = 0.101). Post-operative macular optical coherence tomography was obtained from 95% of successes. Normal macular profile was found in 10% of cases, and the other cases demonstrated exudative maculopathy (60%), tractional maculopathy (20%) and macular atrophy (10%). Final BCVA was significantly higher in eyes with normal macular status compared to eyes with exudative maculopathy (p = 0.045) and macular atrophy (p = 0.025).
Primary retinectomy may be used for rhegmatogenous retinal detachment complicated with advanced proliferative vitreoretinopathy. Anatomical and functional outcome were inferior than non-primary retinectomies for grade C proliferative vitreoretinopathy. Functional outcome was influenced by macular status. Positive prognostic factors include final anatomical success and normal final macular anatomy.
与玻璃体切除术后眼的非原发性视网膜切除术不同，在以前未行玻璃体切除术的眼中进行原发性视网膜切除术在少数病例中很少进行。
本文旨在确定原发性视网膜切除术的解剖和功能结果，并评估成功病例中的黄斑结构变化。
在这项回顾性多中心队列研究中，纳入了2014年至2021年间因孔源性视网膜脱离合并增殖性玻璃体视网膜病变C级或D级而首次接受玻璃体切除术的35例原发性视网膜切除术患者。成功组的平均随访时间为48±59.24个月，失败组为46.54±20.99个月（p = 0.483）。
一次视网膜切除术后解剖成功率为48.5%，两次视网膜切除术后为60%。术后平均最佳矫正视力（BCVA）为1.85±0.62 logMAR（相当于Snellen视力表的6/425）。与术前平均BCVA的差异不显著（p = 0.312）。17%的病例最终BCVA≥6/60，无一例获得≥6/24的视力。成功病例术后最终平均BCVA为1.69±0.60 logMAR（相当于Snellen视力表的6/294），而失败病例为2.10±0.57 logMAR（相当于Snellen视力表的6/756）（p = 0.101）。95%的成功病例进行了术后黄斑光学相干断层扫描。10%的病例黄斑形态正常，其他病例表现为渗出性黄斑病变（60%）、牵拉性黄斑病变（20%）和黄斑萎缩（10%）。黄斑状态正常的眼最终BCVA显著高于渗出性黄斑病变眼（p = 0.045）和黄斑萎缩眼（p = 0.025）。
原发性视网膜切除术可用于治疗合并晚期增殖性玻璃体视网膜病变的孔源性视网膜脱离。对于C级增殖性玻璃体视网膜病变，解剖和功能结果不如非原发性视网膜切除术。功能结果受黄斑状态影响。阳性预后因素包括最终解剖成功和最终黄斑解剖结构正常。
