Agarwal Aniruddha, Menia Nitin Kumar, Markan Ashish, Sallam Ahmed B, Habib Ahmed, Mansour Ahmed, Iovino Claudio, Peiretti Enrico, Demirel Sibel, Tawfiq Mohamed Ahmed, Hanout Mostafa, Gupta Vishali, Ghazi Nicola, Sengupta Sabyasachi
The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE).
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
Indian J Ophthalmol. 2024 Dec 1;72(12):1772-1779. doi: 10.4103/IJO.IJO_2840_23. Epub 2024 Apr 16.
To analyze the visual and anatomical outcomes for eyes with rhegmatogenous retinal detachment (RRD) and advanced proliferative vitreoretinopathy (PVR) undergoing giant peripheral retinotomy (GPR) using 25-gauge pars plana vitrectomy (PPV).
In this retrospective multi-center study, patients with RRD with either anteroposterior or circumferential retinal shortening and advanced PVR requiring more than 90-degree GPR with/without relaxing retinotomy were included. Subjects of either gender, any age group, and with complete surgical notes were included. Outcome measures of the study included anatomical success (i.e. complete retinal re-attachment) at 6 months using survival analysis, visual outcomes, and post-operative complications.
Forty-one eyes of 41 patients (33 males) with a mean age of 44.9 ± 21.4 years were included. At 6 months follow-up, anatomical success was seen in 29 eyes (70.7%) with a cumulative re-attachment rate of 66% (95% confidence interval = 48 = 79%). All re-detachments occurred at ≤6 months with a peak at 4-6 months (n = 9). Twenty-three eyes (56%) achieved ambulatory vision (5/200) or better. Direct perfluorocarbon liquid-silicone oil exchange was performed in 20 eyes. Intra-operative complications included persistent retinal folds (2 eyes), subretinal air (1 eye), and subretinal bleed (1 eye). Eleven eyes (26.8%) developed secondary glaucoma (2 eyes required a drainage device), and hypotony of ≤6 mmHg was noted in 3 eyes (7.3%). Corneal decompensation was noted in 8 eyes (19.5%), and 3 eyes (7.3%) underwent re-surgery for re-RRD.
After GPR using small gauge PPV, two-thirds achieve anatomical success, and over half have ambulatory vision, but overall post-operative complications can occur in more than half of the eyes.
分析采用25G经平坦部玻璃体切除术（PPV）行巨大周边视网膜切开术（GPR）治疗孔源性视网膜脱离（RRD）合并晚期增殖性玻璃体视网膜病变（PVR）患眼的视觉和解剖学转归。
在这项回顾性多中心研究中，纳入了患有前后或环形视网膜缩短的RRD且需要超过90度GPR（无论有无松解性视网膜切开术）的晚期PVR患者。纳入任何性别、任何年龄组且有完整手术记录的受试者。该研究的转归指标包括使用生存分析评估6个月时的解剖学成功（即视网膜完全复位）、视觉转归和术后并发症。
纳入了41例患者（33例男性）的41只眼，平均年龄为44.9±21.4岁。在6个月的随访中，29只眼（70.7%）实现了解剖学成功，累积复位率为66%（95%置信区间=48=79%）。所有视网膜再次脱离均发生在≤6个月时，在4-6个月时达到高峰（n=9）。23只眼（56%）获得了可走动视力（5/200）或更好。20只眼进行了直接全氟碳液体-硅油置换。术中并发症包括持续性视网膜皱褶（2只眼）、视网膜下气体（1只眼）和视网膜下出血（1只眼）。11只眼（26.8%）发生了继发性青光眼（2只眼需要引流装置），3只眼（7.3%）出现了≤6 mmHg的低眼压。8只眼（19.5%）出现角膜失代偿，3只眼（7.3%）因视网膜再次脱离接受了再次手术。
在使用小口径PPV进行GPR后，三分之二的患眼实现了解剖学成功，超过一半的患眼获得了可走动视力，但超过一半的患眼可能会出现总体术后并发症。
