Grizzard W S, Hilton G F, Hammer M E, Taren D, Brinton D A
Department of Ophthalmology, University of South Florida College of Medicine, Tampa, USA.
Ophthalmology. 1995 Jun;102(6):929-36. doi: 10.1016/s0161-6420(95)30932-3.
Pneumatic retinopexy is a procedure for reattaching the retina by injecting an expanding gas bubble and using either laser or cryopexy. The procedure is controversial because there may be a lower initial success rate, and intraocular gas may increase the risk of proliferative vitreoretinopathy.
The authors performed a retrospective review of 107 unpublished consecutive cases of pneumatic retinopexy together with a literature review of 25 statistical series with primary attention to failures. Univariate and multivariate analyses were carried out on the data set, and adjusted odds ratios for risk factors associated with failure were calculated using logistic regression.
Initially, 74 (69%) of 107 patients had successful results, and with re-operations the success rate increased to 98%. Failure of the procedure to achieve retinal reattachment occurred soon after the initial procedure, with 86% of recorded failures occurring within the first month. The initial cause of failure was new or missed breaks in 14.9%, reopened initial breaks in 11.2%, and breaks never closed in 4.6%. Risk factors that showed a correlation with failure were patients being male (adjusted odds ratio = 2.65), eyes with preoperative visual acuity worse than 20/50 (adjusted odds ratio = 1.21), eyes with four quadrants of retinal detachment or total detachment (adjusted odds ratio = 2.03), aphakic or pseudophakic eyes (adjusted odds ratio = 1.91), and eyes with additional pathologic findings (adjusted odds ratio = 3.14). Poor visual outcome was associated with initial visual acuity less than 20/50 (adjusted odds ratio = 15.7) and eyes with four quadrants of retinal detachment or total detachment (adjusted odds ratio = 5.01).
Failures of pneumatic retinopexy occur early in the postoperative course. Factors known to be associated with failure of retinal reattachment using scleral buckling also were associated with failure in pneumatic retinopexy. A higher success rate in females was noted, suggesting that educational efforts may need to be greater in males. Poorer visual results occurred in patients with poor initial vision and in eyes with four quadrants of retinal detachment or total detachments.
气体视网膜固定术是一种通过注入膨胀的气泡并使用激光或冷冻疗法使视网膜复位的手术。该手术存在争议，因为其初始成功率可能较低，且眼内气体可能会增加增殖性玻璃体视网膜病变的风险。
作者对107例未发表的连续气体视网膜固定术病例进行了回顾性分析，并对25个统计学系列的文献进行了综述，主要关注手术失败情况。对数据集进行了单因素和多因素分析，并使用逻辑回归计算了与失败相关的危险因素的调整比值比。
最初，107例患者中有74例（69%）手术成功，经过再次手术，成功率提高到了98%。手术未能实现视网膜复位的情况在初次手术后不久就会出现，记录的失败病例中有86%发生在第一个月内。失败的初始原因包括新的或遗漏的裂孔占14.9%，初次裂孔重新开放占11.2%，裂孔未闭合占4.6%。与失败相关的危险因素包括男性患者（调整比值比 = 2.65）、术前视力低于20/50的眼睛（调整比值比 = 1.21）、视网膜脱离累及四个象限或全脱离的眼睛（调整比值比 = 2.03）、无晶状体或人工晶状体眼（调整比值比 = 1.91）以及有其他病理表现的眼睛（调整比值比 = 3.14）。视力预后不佳与初始视力低于20/50（调整比值比 = 15.7）以及视网膜脱离累及四个象限或全脱离的眼睛（调整比值比 = 5.01）有关。
气体视网膜固定术的失败发生在术后早期。已知与巩膜扣带术视网膜复位失败相关的因素在气体视网膜固定术中也与失败有关。女性的成功率较高，这表明可能需要对男性加大教育力度。初始视力差以及视网膜脱离累及四个象限或全脱离的患者视力预后较差。
