Banker A S, Freeman W R, Kim J W, Munguia D, Azen S P
Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla 92093-0946, USA.
Ophthalmology. 1997 Sep;104(9):1442-52; discussion 1452-3. doi: 10.1016/s0161-6420(97)30118-3.
To study complications of vitrectomy surgery for full-thickness macular holes.
A multicentered, randomized, controlled clinical trial.
Community and university-based ophthalmology clinics.
Standardized macular hole surgery versus observation.
Assessment of anatomic and visual outcomes and determination of postoperative complications at 12 months after randomization.
Posterior segment complications were noted in 39 eyes (41%). The incidence of retinal pigment epithelium (RPE) alteration and retinal detachment (RD) were 33% and 11%, respectively. One RD due to a giant retinal tear resulted in a visual acuity of light perception. Other complications included a reopening of the macular hole in 2 eyes (2%), cystoid macular edema in 1 eye (1%), a choroidal neovascular membrane in 1 eye (1%) and endophthalmitis in 1 eye (1%). Eyes with complications had significantly worse visual acuity outcomes as determined by the Early Treatment Diabetic Retinopathy Study, Word Reading, and Potential Acuity Meter charts (P < 0.01 for all comparisons). Eyes with macular holes greater than 475 microns were more than twice as likely to have complications than eyes with holes less than 475 microns (odds ratio [OR] = 2.2, P = 0.07). Before surgery, the stage of the hole was related to postoperative RPE changes (P < 0.0001) and the occurrence of postoperative RD (P = 0.0002). Intraoperative trauma was related to the occurrence of these complications (P < 0.0001 for RPE changes, P = 0.02 for RDs). Epiretinal membrane removal was related to RPE changes (P = 0.02) but not RDs.
The RPE alterations and RDs are common after macular hole surgery and result in significantly reduced postoperative visual acuity. The RPE changes may be related to surgical trauma or light toxicity. Further efforts to reduce complications associated with macular hole surgery are indicated.
研究全层黄斑裂孔玻璃体切除术的并发症。
一项多中心、随机、对照临床试验。
社区和大学眼科诊所。
标准化黄斑裂孔手术与观察。
随机分组后12个月时评估解剖和视力结果，并确定术后并发症。
39只眼（41%）出现后段并发症。视网膜色素上皮（RPE）改变和视网膜脱离（RD）的发生率分别为33%和11%。1例因巨大视网膜裂孔导致的视网膜脱离导致视力为光感。其他并发症包括2只眼（2%）黄斑裂孔重新开放，1只眼（1%）黄斑囊样水肿，1只眼（1%）脉络膜新生血管膜，1只眼（1%）眼内炎。根据早期糖尿病视网膜病变研究、单词阅读和潜在视力表图表，有并发症的眼视力结果明显更差（所有比较P<0.01）。黄斑裂孔大于475微米的眼发生并发症的可能性是裂孔小于475微米的眼的两倍多（优势比[OR]=2.2，P=0.07）。手术前，裂孔的阶段与术后RPE变化（P<0.0001）和术后RD的发生（P=0.0002）有关。术中创伤与这些并发症的发生有关（RPE变化P<0.0001，RDs P=0.02）。视网膜前膜切除与RPE变化有关（P=0.02），但与RDs无关。
黄斑裂孔手术后RPE改变和RDs很常见，导致术后视力显著下降。RPE变化可能与手术创伤或光毒性有关。需要进一步努力减少与黄斑裂孔手术相关的并发症。
