Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
BMC Ophthalmol. 2024 Apr 22;24(1):184. doi: 10.1186/s12886-024-03437-2.
To compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade.
All consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded.
Overall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).
Surgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.
The trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).
比较巨孔视网膜脱离（GRT）伴黄斑脱离的眼在接受玻璃体切除术（PPV）时因使用内眼填充物而导致的结果。
回顾性评估了 2007 年至 2022 年间接受 PPV 治疗的巨孔视网膜脱离（RRD）伴黄斑脱离的连续病例，根据选择的内眼填充物进行分类。通过查阅病历和手术方案，详细分析了术前和术中参数。评估了重新附着所需的玻璃体视网膜（VR）手术次数、再脱离率和功能结果。将硅油（SO）初次填充治疗的眼与初次气体填充治疗的眼进行比较。排除了影响结果的预先存在的情况，例如黄斑脱离、外伤史、复杂白内障手术后、以前的 VR 手术或增殖性玻璃体视网膜病变 C 级或更高的病例。
在观察期间，51 只眼睛（45 名患者）接受了 PPV 治疗，其中 32 只（63%）眼睛接受了 SO 内眼填充物治疗，19 只（37%）眼睛接受了气体内眼填充物治疗。初次 SO 填充治疗的眼平均需要进行 2.3 次（SD 0.8）VR 手术，再脱离率为 13%（n=4）。气体填充治疗的眼再脱离率较高，为 32%（n=6），平均需要进行 1.6 次（SD 1.0）PPV 手术。初次气体填充治疗的眼术后最佳矫正视力（BCVA）明显优于初次 SO 填充治疗的眼（平均 logMAR BCVA 0.32；SD 0.30）（p=0.008）。
GRT 相关 RRD 的手术治疗较为复杂。在临床实践中，SO 通常被用作内眼填充物。由于已知的缺点（需要第二次手术取出 SO、无法解释的 SO 相关视力丧失、继发性青光眼、SO 乳化），一些 VR 外科医生更喜欢气体填充。在我们的队列中，与 SO 填充治疗的眼相比，气体填充治疗的眼再脱离率更高。然而，与 SO 填充治疗的眼相比，气体填充治疗的眼最终术后 BCVA 明显更好。
当地伦理委员会于 2022 年 11 月 25 日批准了该试验方案（雷根斯堡大学伦理委员会，投票 22-3166-104）。
