Körner F, Böhnke M
Universitäts-Augenklinik Bern, Abteilung für vitreoretinale Erkankungen.
Klin Monbl Augenheilkd. 1995 Apr;206(4):239-45. doi: 10.1055/s-2008-1035432.
Modern vitreoretinal surgery allows a successful management of most cases of retinal detachment (RD) due to proliferative vitreoretinopathy (PVR). Failure of a vitrectomy in these cases is generally caused by a recurrence of PVR. Little is known about the postoperative 'life cycle' of proliferative cellular processes within the periretinal space. An adequate retreatment of PVR recurrences may improve the anatomical and functional results of a vitrectomy.
The retrospective study comprises 501 consecutive eyes operated for non-diabetic traction RD. Conventional retinal surgery preceded the vitrectomy in 36% of the cases. PVR was staged according to the classification of the Retina Society (14) with supplemental stages for 'anterior loop' formation, epimacular and subretinal membranes. The mean follow up of 139 eyes with one single vitrectomy was 24.2 months. The time-course of recurrent PVR in 362 eyes (72%, mean follow-up 34.2 months) was analyzed. Silicone-oil tamponade was used in 343 (69%) eyes.
Recurrent PVR occurred predominantly within 1 to 9 months (median 1.8 mos) after vitrectomy. Latencies of recurrences did not differ significantly between PVR-C and D stages. Reattachment of the retina was achieved in about 85% of PVR-C and 70% of PVR-D stages. Anatomical results were better in non-traumatic RD cases. Final visual acuity of eyes operated since 1990 was 5/200 or better in 78% C-stages and 65% D-stages (follow-up of > or = 12 months). The final visual acuity was 20/100 or better in 33% of all PVR-C cases and 9.5% of all PVR-D cases. Significantly improved visual results were achieved in eyes operated with silicone oil tamponade, and in the later series of 279 eyes operated since 1990. The rate of postoperative total blindness was reduced from 16.7% before 1990 to 3.6% after 1990.
Blindness due to traction RD can be avoided by vitreoretinal surgery in about 75% of PVR-C and over 50% of PVR-D cases provided that PVR recurrences are detected early and treated adequately.
现代玻璃体视网膜手术能够成功治疗大多数因增生性玻璃体视网膜病变（PVR）导致的视网膜脱离（RD）病例。这些病例中玻璃体切除术失败通常是由PVR复发引起的。对于视网膜周间隙内增生性细胞过程的术后“生命周期”知之甚少。对PVR复发进行充分的再次治疗可能会改善玻璃体切除术的解剖和功能结果。
这项回顾性研究包括501只连续接受非糖尿病性牵引性RD手术的眼睛。36%的病例在玻璃体切除术之前进行了传统视网膜手术。根据视网膜协会的分类（14）对PVR进行分期，并对“前环”形成、黄斑前和视网膜下膜补充分期。139只接受单次玻璃体切除术的眼睛的平均随访时间为24.2个月。分析了362只眼睛（72%，平均随访34.2个月）复发性PVR的时间进程。343只眼睛（69%）使用了硅油填塞。
复发性PVR主要发生在玻璃体切除术后1至9个月（中位数1.8个月）。PVR-C和D期复发的潜伏期没有显著差异。PVR-C期约85%和PVR-D期约70%的视网膜实现了复位。非创伤性RD病例的解剖结果更好。自1990年以来接受手术的眼睛，C期最终视力在78%的病例中为5/200或更好，D期为65%（随访≥12个月）。所有PVR-C病例中33%和所有PVR-D病例中9.5%的最终视力为20/100或更好。使用硅油填塞进行手术的眼睛以及自1990年以来手术的279只眼睛的后期系列中，视力结果有显著改善。术后全盲率从1990年前的16.7%降至1990年后的3.6%。
如果能早期发现并充分治疗PVR复发，玻璃体视网膜手术可避免约75%的PVR-C病例和超过50%的PVR-D病例因牵引性RD导致失明。
