Freyler H, Radax U
1. Univ. Augenklinik Wien.
Klin Monbl Augenheilkd. 1993 Mar;202(3):212-7. doi: 10.1055/s-2008-1045585.
The goal of this study is the evaluation of effectivity and the complications of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachment as a long-term follow-up.
This retrospective long-term study covers 89 eyes with rhegmatogenous retinal detachment treated by pneumatic retinopexy between January 1985 and December 1991. With a postoperative follow-up averaging 4.8 years, it constitutes the longest such period published to-date in literature.
The first intervention induced anatomical healing in 73% of all cases. However, 5.5% relapsed with retinal detachment after one month. Following a second intervention (excepting 2 cases) performed with conventional retinal detachment surgery consisting of exoplants + kryopexy + subretinal drainage, successrate was stepped up 97%. A total of 5 eyes required maximum surgery, i.e. vitrectomy + silicone oil tamponade. In 3% this procedure presented the third intervention. Finally anatomical healing was attained in 100% of the eyes. However, after one month 18% developed new retinal tears and after a follow-up period of 5.5 years this figure had risen to 27.7%.
Judged on the basis of the above results, pneumatic retinopexy should only be recommended for the very simplest cases of rhegmatogenous retinal detachment (a single tear in the upper fundus half between 10 and 2 o'clock and no pathological changes in the lower fundus half). Also, check-ups at short intervals are required following pneumatic retinopexy. In our opinion standard buckling surgery with additional gas tamponade is preferable.
本研究的目的是对气体视网膜固定术治疗孔源性视网膜脱离的有效性及并发症进行长期随访评估。
这项回顾性长期研究涵盖了1985年1月至1991年12月期间接受气体视网膜固定术治疗的89例孔源性视网膜脱离患者的眼睛。术后平均随访4.8年,这是迄今为止文献中发表的最长随访期。
首次干预使73%的病例实现了解剖复位。然而,5.5%的患者在术后1个月视网膜脱离复发。在进行第二次干预(2例除外)时,采用包括外植体+冷凝+视网膜下引流的传统视网膜脱离手术,成功率提高到了97%。共有5只眼睛需要进行最大程度的手术,即玻璃体切除术+硅油填充。在3%的病例中,该手术是第三次干预。最终所有眼睛均实现了解剖复位。然而,术后1个月有18%的患者出现了新的视网膜裂孔,随访5.5年后这一数字升至27.7%。
基于上述结果,气体视网膜固定术仅应推荐用于非常简单的孔源性视网膜脱离病例(眼底上半部分10点至2点之间单个裂孔,眼底下半部分无病理改变)。此外,气体视网膜固定术后需要短时间间隔进行检查。我们认为,标准的巩膜扣带术联合气体填充更为可取。