[德国孔源性视网膜脱离的治疗现状及围手术期定位策略：retina.net调查结果]
[Current trends in the treatment of rhegmatogenous retinal detachment and perioperative positioning strategies in Germany: results of a retina.net survey].
作者信息
Strzalkowski Piotr, Strzalkowska Alicja, Stahl Andreas, Schuster Alexander K, Kaya Sema, Roth Mathias, Krohne Tim U, Finger Robert P, Schaub Friederike, Dithmar Stefan, Framme Carsten, Wolf Armin, Spitzer Martin, Agostini Hansjürgen, Feltgen Nicolas, Zeitz Oliver, Klaas Julian, Hillenkamp Jost, Pielen Amelie, Helbig Horst, Grisanti Salvatore, Hoerauf Hans, Bechrakis Nikolaos E, Walter Peter, Roider Johann, Schrecker Jens, Ach Thomas, Barth Teresa, Tode Jan, Geerling Gerd, Guthoff Rainer
机构信息
Klinik für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland.
Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Greifswald, Greifswald, Deutschland.
出版信息
Ophthalmologie. 2025 May;122(5):383-392. doi: 10.1007/s00347-025-02216-8. Epub 2025 Mar 24.
BACKGROUND
Rhegmatogenous retinal detachment (RRD) is an ophthalmological emergency with an increasing incidence in Germany. Despite established methods, perioperative positioning is important to improve outcomes and avoid complications but may be challenging, particularly in immobile patients. An analysis of the current trends in surgical treatment and perioperative positioning practices for RRD in Germany compared to historical data from 2018 is essential.
MATERIAL AND METHODS
An online survey with five hypothetical cases of acute RRD was distributed to vitreoretinal surgeons via the retina.net research network. A total of 27 questionnaires were analyzed focusing on participant demographic data, surgical techniques, anesthesia types, perioperative positioning and aftercare strategies.
RESULTS
Of the respondents 50% were over 50 years old, 86% worked at university eye clinics and 89% had performed over 1000 vitreoretinal procedures. For RRD in the temporal upper quadrant, preoperative and postoperative temporal lateral positioning is recommended. Of the respondents 86% consider postoperative positioning crucial to prevent macular folds. Complete subretinal fluid drainage is favored by 82% and 23 G trocars were used by 77%. For phakic eyes with uncomplicated RRD 86% chose buckling surgery, while 50% opted for silicone oil in complex inferior RRD cases. General anesthesia was preferred by 61%, always in an in-patient setting.
CONCLUSION
Preoperative and postoperative temporal lateral positioning followed by prone positioning is favored for temporal upper quadrant RRD, whereas no specific positioning is recommended for inferior RRD managed with silicone oil or buckling surgery. Postoperative positioning after pars plana vitrectomy (ppV) and gas endotamponade is considered by 86% to be decisive in preventing macular folds. The 23 G trocar system remains the preferred choice despite smaller alternatives. In certain cases buckling is still of importance.
背景
孔源性视网膜脱离（RRD）是一种眼科急症，在德国的发病率呈上升趋势。尽管已有既定方法，但围手术期的体位摆放对于改善手术效果和避免并发症很重要，但可能具有挑战性，尤其是对于行动不便的患者。将德国RRD的当前手术治疗趋势和围手术期体位摆放实践与2018年的历史数据进行比较分析至关重要。
材料与方法
通过retina.net研究网络向玻璃体视网膜外科医生分发了一份包含5个急性RRD假设病例的在线调查问卷。共分析了27份问卷，重点关注参与者的人口统计学数据、手术技术、麻醉类型、围手术期体位摆放和术后护理策略。
结果
在受访者中，50%年龄超过50岁，86%在大学眼科诊所工作，89%进行过1000多次玻璃体视网膜手术。对于颞上象限的RRD，建议术前和术后采用颞侧卧位。86%的受访者认为术后体位摆放对于预防黄斑皱褶至关重要。82%的人倾向于完全引流视网膜下液，77%的人使用23G套管针。对于无并发症RRD的有晶状体眼，86%的人选择巩膜扣带术，而在复杂的下方RRD病例中，50%的人选择硅油填充。61%的人首选全身麻醉，且总是在住院环境下进行。
结论
对于颞上象限RRD，术前和术后采用颞侧卧位然后俯卧位是首选，而对于采用硅油填充或巩膜扣带术治疗的下方RRD，不建议采用特定体位。86%的人认为玻璃体切割术（ppV）和气液填充术后的体位摆放对于预防黄斑皱褶起决定性作用。尽管有更小的替代方案，但23G套管针系统仍然是首选。在某些情况下，巩膜扣带术仍然很重要。
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