Mangouritsas G, Rothbächer H H, Heidenkummer P H, Ulbig M W, Kampik A
Augenklinik, Ludwig-Maximilans-Universität München.
Klin Monbl Augenheilkd. 1995 Jan;206(1):20-8. doi: 10.1055/s-2008-1035400.
The evaluation of further risc factors predesposing failure in retinal detachment surgery than those already known to be associated with PVR was the goal of this retrospective study.
The data from 130 cases with unilateral rhegmatogenous retinal detachment treated initially with buckling procedures, were retrospectively reviewed to investigate pre-, intra- and postoperative factors which may predispose anatomical failure in retinal detachment surgery. None of the selected consecutively operated eyes had risk factors, which have already been associated with an unfavourable outcome, such as the presence of preoperative macular holes, PVR or assumed PVR-inducing factors, such as ocular trauma, giant retinal tears, vitreous hemorrhage, previous vitrectomy, cryopexy and laser photocoagulation.
The anatomic success rate after scleral buckling procedures was 78.5% and the overall success rate after multiple surgery including vitrectomy increased to 94.6%. 102 (78.5%) cases, treated with a maximum of two scleral buclking operations were statistically compared to the 28 cases which needed further vitreoretinal surgery. The statistical analysis revealed as preoperative risk factors for failure in rhegmatogenous retinal detachment surgery 1) retinal detachment exceeding two retinal quadrants (p < 0.05) and 2) size of the retinal tear larger than 60 degrees (p < 0.05), whereas postoperative risk factors were 1) presence of subretinal hemorrhage (p < 0.01) and 2) persistent subretinal fluid at least two days after surgery (p < 0.01). Eyes with preoperative visual acuity less than 0.1, pseudophacic eyes with posterior chamber intraocular lenses and eyes with severe intraoperative hypotony also showed a tendency to unfavourable outcome, but without a statistically significant level.
Possible ways of interfering in the retinal reattachment process and the clinical importance of these evaluated factors are discussed. They should be taken in consideration for the prognosis of the postoperative anatomical result and treatment modalities if further surgery is required.
本回顾性研究的目的是评估除了已知与增殖性玻璃体视网膜病变（PVR）相关的因素外，还有哪些因素会增加视网膜脱离手术失败的风险。
回顾性分析130例最初接受巩膜扣带术治疗的单侧孔源性视网膜脱离患者的数据，以研究可能导致视网膜脱离手术解剖学失败的术前、术中和术后因素。所有连续入选的手术眼均无已被证实与不良预后相关的危险因素，如术前黄斑裂孔、PVR或假定的PVR诱发因素，如眼外伤、巨大视网膜裂孔、玻璃体积血、既往玻璃体切除术、冷冻治疗和激光光凝。
巩膜扣带术后解剖学成功率为78.5%，包括玻璃体切除术在内的多次手术后总体成功率提高到94.6%。对最多接受两次巩膜扣带手术的102例（78.5%）患者与需要进一步玻璃体视网膜手术的28例患者进行统计学比较。统计分析显示，孔源性视网膜脱离手术失败的术前危险因素为：1）视网膜脱离超过两个象限（p<0.05）；2）视网膜裂孔大小大于60度（p<0.05），而术后危险因素为：1）视网膜下出血（p<0.01）；2）术后至少两天持续存在视网膜下液（p<0.01）。术前视力低于0.1的眼以及植入后房型人工晶状体的假晶状体眼和术中出现严重低眼压的眼也显示出不良预后的倾向，但无统计学意义。
讨论了干预视网膜复位过程的可能方法以及这些评估因素的临床重要性。如果需要进一步手术，应考虑这些因素对术后解剖结果预后和治疗方式的影响。
