玻璃体切割术治疗伴有黄斑裂孔的视网膜脱离：不同眼轴长度条件下的预后因素分析。

Vitrectomy for retinal detachment associated with macular hole: Prognostic factor analysis under different axial length conditions.

机构信息

National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China.

出版信息

Acta Ophthalmol. 2024 Jun;102(4):e557-e564. doi: 10.1111/aos.15791. Epub 2023 Oct 11.

DOI:10.1111/aos.15791

PMID:37818952

Abstract

PURPOSE

To identify prognostic factors for complete anatomical success (CAS) under different axial length (AL) conditions after vitrectomy plus internal limiting membrane (ILM) peeling for retinal detachment associated with macular hole (MHRD).

METHODS

This retrospective study included 243 patients (251 eyes) with MHRD who underwent primary vitrectomy plus ILM peeling. Multivariate logistic regression explored prognostic factors for CAS in AL <30 mm and ≥ 30 mm groups.

RESULTS

Overall, 113 eyes (45.0% of 251) exhibited complete CAS after initial surgery. Eyes with CAS had greater best-corrected visual acuity improvement than eyes without CAS (p < 0.001). CAS was more common in eyes with AL < 30 mm (50.3% of 155) than in eyes with AL ≥ 30 mm (36.5%, 35/96; p = 0.032). In the AL < 30 mm group, CAS was associated with ILM insertion (odds ratio [OR], 2.824, 95% confidence interval [CI], 1.189-6.710; p = 0.019), silicone oil (SO)/perfluoropropane (C3F8) tamponade (SO: OR, 0.408, 95% CI, 0.191-0.873; C3F8: OR, 2.448, 95% CI, 1.145-5.234; p = 0.021) and staphyloma (OR, 0.318, 95% CI, 0.143-0.707; p = 0.005). In the AL ≥30 mm group, CAS was associated with ILM insertion (OR, 11.621, 95% CI, 2.557-52.813; p = 0.001), SO /C3F8 tamponade (SO: OR, 5.305, 95% CI, 1.206-23.334; C3F8: OR, 0.188, 95% CI, 0.043-0.829; p = 0.027) and age (OR, 0.928, 95% CI, 0.876-0.983; p = 0.011).

CONCLUSION

Vitrectomy plus ILM peeling can effectively treat MHRD but has limited efficacy in eyes with AL ≥ 30 mm. ILM insertion was associated with more frequent CAS at any AL. C3F8 tamponade yielded better outcomes with AL < 30 mm; SO tamponade yielded better outcomes with AL ≥ 30 mm.

摘要

目的

确定不同眼轴（AL）条件下玻璃体切除联合内界膜（ILM）剥除治疗与黄斑裂孔（MHRD）相关视网膜脱离（MHRD）后完全解剖成功（CAS）的预后因素。

方法

本回顾性研究纳入了 243 例（251 只眼）接受初次玻璃体切除联合 ILM 剥除治疗的 MHRD 患者。多变量逻辑回归分析用于探讨 AL <30mm 和≥30mm 组中 CAS 的预后因素。

结果

总体而言，初次手术后 113 只眼（251 只眼中的 45.0%）表现出完全 CAS。具有 CAS 的眼比无 CAS 的眼有更大的最佳矫正视力改善（p<0.001）。AL<30mm 的眼中 CAS 更常见（50.3%，155 只眼中的 78 只），而 AL≥30mm 的眼中 CAS 更常见（36.5%，96 只眼中的 35 只；p=0.032）。在 AL<30mm 组中，CAS 与 ILM 插入（比值比[OR]，2.824，95%置信区间[CI]，1.189-6.710；p=0.019）、硅油（SO）/全氟丙烷（C3F8）填充（SO：OR，0.408，95%CI，0.191-0.873；C3F8：OR，2.448，95%CI，1.145-5.234；p=0.021）和葡萄肿（OR，0.318，95%CI，0.143-0.707；p=0.005）有关。在 AL≥30mm 组中，CAS 与 ILM 插入（OR，11.621，95%CI，2.557-52.813；p=0.001）、SO/C3F8 填充（SO：OR，5.305，95%CI，1.206-23.334；C3F8：OR，0.188，95%CI，0.043-0.829；p=0.027）和年龄（OR，0.928，95%CI，0.876-0.983；p=0.011）有关。