Leaver P K
Moorfields Eye Hospital, London, United Kingdom.
Ger J Ophthalmol. 1993 Feb;2(1):20-3.
A total of 39 eyes of 39 patients, previously reviewed 5 years after vitrectomy and fluid/silicone oil exchange for giant retinal tears, were reexamined after 10 years. The retina remained attached in 30 eyes (77%), and in no case had redetachment occurred in the interval between 5 and 10 years after surgery. In all, 3 groups of eyes were identified, 20 eyes with attached retinas and visual acuities of 6/60 or better (group I), 10 with attached retinas and vision of less than 6/60 (group II) and 9 in which the retina was detached (group III). Eyes in group I were found to be stable, with future improvement anticipated in some cases with cataracts. A majority of group II eyes were deteriorating due to glaucoma and keratopathy. Failure in group III was due to proliferative vitreoretinopathy in all except one instance. Measures aimed at reducing the incidence of epiretinal membrane proliferation, glaucoma and keratopathy are recommended to improve long-term results in the treatment of retinal detachments complicated by giant retinal tears. These include the use of safer methods of retinopexy, preservation of the lens when possible, early removal of silicone oil and a reduction in the use of scleral buckles.
对39例患者的39只眼睛进行了复查，这些患者曾在玻璃体切除联合液体/硅油置换治疗巨大视网膜裂孔术后5年接受过检查，此次是在术后10年进行复查。30只眼睛（77%）的视网膜保持附着状态，在术后5至10年期间无一例视网膜再次脱离。总体上，确定了3组眼睛，20只视网膜附着且视力为6/60或更好的眼睛（I组），10只视网膜附着但视力低于6/60的眼睛（II组），以及9只视网膜脱离的眼睛（III组）。发现I组眼睛情况稳定，部分患有白内障的病例预期未来视力会有所改善。II组的大多数眼睛因青光眼和角膜病变而视力恶化。III组手术失败除1例之外均是由于增殖性玻璃体视网膜病变所致。建议采取措施降低视网膜前膜增殖、青光眼和角膜病变的发生率，以改善巨大视网膜裂孔并发视网膜脱离治疗的长期效果。这些措施包括采用更安全的视网膜固定术方法、尽可能保留晶状体、早期取出硅油以及减少巩膜扣带术的使用。
