Kreissig I, Simader E, Rose D
Abteilung und Lehrstuhl III, Universitäts-Augenklinik Tübingen.
Klin Monbl Augenheilkd. 1994 Dec;205(6):336-43. doi: 10.1055/s-2008-1045540.
The following questions should be addressed: (1) Is minimal detachment surgery justified in treating detachments with preoperative PVR stage B or C? (2) Can this reattach the retina with stabilization or regression of PVR?
72 PVR detachments stage B or C (38 C1, 11 C2, 1 C3) were treated by cryopexy, segmental buckling (n = 68) or balloon (n = 4) without drainage or vitrectomy. Reoperation (n = 10) was done without cerclage or vitrectomy. The follow-up of patients alive is 11 to 13 1/2 years and of all patients (31 died) x 7 1/2 years.
After the primary operation the retina was reattached in 79%, partially in 15% and detached in 6%. An "early" redetachment (< or = 6 months postoperatively) occurred in 8.3%, no redetachment > 6 months to < 9 years and "late" redetachment (9-13 1/2 years postoperatively) in 2.8%. After reoperation (n = 10) the retina was reattached in 85%, partially in 3%, and detached in 12%. 34 eyes had delayed resorption (2 weeks to 18 months) with a residual concave detachment in area of starfolds and tractions, resulting in dry starfolds or their disappearance after months. Postoperatively there were no rubeosis iridis, no secondary glaucoma and no phthisis bulbi. Subsequent macular pucker developed in 12 eyes, which were not treated by vitreoretinal surgery. Six months postoperatively visual acuity was: 26x 20/60-20/25; 16x 20/200-20/100; 30x < or = 20/400 which was not statistically significant different (p = 0.549) after x 7 1/2 years.
Primary treatment of a PVR detachment stage B or C1/C2 with cryopexy and segmental buckling and nondrainage seems justified to test for the chance of PVR-regression. The retina was reattached in 8 of 10 patients x 7 1/2 years postoperatively after primary operation without reoperation or vitrectomy and visual acuity was 20/60-20/25 in every third patient, thus implying a lack of late serious complications.
应解决以下问题：（1）对于术前PVR分级为B或C级的视网膜脱离，进行最小程度的脱离手术是否合理？（2）这能否使视网膜复位并使PVR稳定或消退？
72例PVR分级为B或C级（38例C1级，11例C2级，1例C3级）的视网膜脱离患者，采用冷冻疗法、节段性巩膜外加压术（n = 68）或球囊术（n = 4）进行治疗，不进行引流或玻璃体切除术。10例患者进行了再次手术，未进行环扎或玻璃体切除术。存活患者的随访时间为11至13.5年，所有患者（31例死亡）的平均随访时间为7.5年。
初次手术后，79%的患者视网膜复位，15%部分复位，6%仍脱离。8.3%的患者发生“早期”再脱离（术后≤6个月），6个月至<9年无再脱离，“晚期”再脱离（术后9 - 13.5年）发生率为2.8%。再次手术后（n = 10），85%的患者视网膜复位，3%部分复位，12%仍脱离。34只眼出现延迟吸收（2周至18个月），在星状皱襞和牵引区域残留凹陷性脱离，数月后导致干性星状皱襞或其消失。术后无虹膜红变、无继发性青光眼，眼球也未萎缩。12只未接受玻璃体视网膜手术治疗的眼出现了黄斑前膜。术后6个月时的视力情况为：26例患者视力为20/60 - 20/25；16例患者视力为20/200 - 20/100；30例患者视力≤20/400，7.5年后差异无统计学意义（p = 0.549）。
对于PVR分级为B或C1/C2级的视网膜脱离，采用冷冻疗法、节段性巩膜外加压术且不进行引流的初次治疗似乎合理，可用于测试PVR消退的可能性。初次手术后，10例患者中有8例在术后7.5年无需再次手术或玻璃体切除术视网膜即已复位，每三名患者中就有一名患者的视力为20/60 - 20/25，这意味着没有晚期严重并发症。
