Cicinelli Maria Vittoria, Benatti Eleonora, Starace Vincenzo, Nadin Francesco, Di Nisi Edoardo, Bandello Francesco, Coppola Michele
Ophthalmology Unit, Azienda Ospedaliera di Monza, Monza, Italy.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Ophthalmol Ther. 2023 Dec;12(6):3219-3232. doi: 10.1007/s40123-023-00811-z. Epub 2023 Sep 29.
This study investigates factors associated with recurrent rhegmatogenous retinal detachment (RRD), macular complications, and visual outcomes after pars plana vitrectomy (PPV) without perfluorocarbon liquids (PFCLs) for primary RRD.
A longitudinal cohort study included consecutive patients with RRD who underwent PFCL-free PPV. Postoperative visual acuity and spectral-domain optical coherence tomography findings [cystoid macular edema (CME), epiretinal membrane (ERM), ellipsoid zone/interdigitation zone (EZ/IZ) damage] were collected. Logistic regression and linear mixed models analyzed rates and risk factors for RRD recurrence, CME, ERM, EZ/IZ damage, and visual acuity at 12 months.
346 eyes with RRD were studied. Single-operation success rates were 96% and 93% for uncomplicated (n = 274 eyes) and complicated (n = 72 eyes) RRD, respectively. Factors associated with RRD recurrence were posterior retinal breaks [odds ratio (OR) = 10.7 compared to peripheral retinal breaks, p = 0.008], silicone oil tamponade (OR = 5.66 compared to gas, p = 0.01), and sectorial laser retinopexy (OR = 4.34 compared to 360° laser retinopexy, p = 0.007). The prevalence of CME, ERM, and EZ/IZ damage at 12 months was 10%, 9%, and 6%, respectively. Eyes with EZ/IZ defects had worse postoperative visual acuity in both uncomplicated and complicated RRD. Proliferative vitreoretinopathy (OR = 2.95, p = 0.03) and silicone oil tamponade (OR = 3.70 compared to gas, p = 0.05) were associated with EZ/IZ damage.
PFCL-free PPV demonstrated satisfactory single-operation success rates for uncomplicated and complicated RRD, with a low prevalence of macular complications. Analyzing factors associated with RRD recurrence can provide provisional recommendations for PFCL-free approaches in the absence of randomized trials.
本研究调查了在原发性孔源性视网膜脱离（RRD）的玻璃体切除术（PPV）中，不使用全氟碳液体（PFCL）时，与复发性RRD、黄斑并发症及视力预后相关的因素。
一项纵向队列研究纳入了连续接受无PFCL的PPV的RRD患者。收集术后视力及频域光学相干断层扫描结果[黄斑囊样水肿（CME）、视网膜前膜（ERM）、椭圆体带/指状交叉带（EZ/IZ）损伤]。采用逻辑回归和线性混合模型分析RRD复发、CME、ERM、EZ/IZ损伤的发生率及危险因素，以及12个月时的视力情况。
对346只RRD患眼进行了研究。单纯性RRD（n = 274只眼）和复杂性RRD（n = 72只眼）的单次手术成功率分别为96%和93%。与RRD复发相关的因素有视网膜后裂孔（与周边视网膜裂孔相比，比值比[OR]=10.7，p = 0.008）、硅油填充（与气体填充相比，OR = 5.66，p = 0.01）以及扇形激光视网膜光凝（与360°激光视网膜光凝相比，OR = 4.34，p = 0.007）。12个月时CME、ERM和EZ/IZ损伤的发生率分别为10%、9%和6%。在单纯性和复杂性RRD中，存在EZ/IZ缺陷的患眼术后视力较差。增殖性玻璃体视网膜病变（OR = 2.95，p = 0.03）和硅油填充（与气体填充相比，OR = 3.70，p = 0.05）与EZ/IZ损伤相关。
无PFCL的PPV对单纯性和复杂性RRD均显示出令人满意的单次手术成功率，黄斑并发症发生率较低。在缺乏随机试验的情况下，分析与RRD复发相关的因素可为无PFCL手术方法提供初步建议。
