Davis J L, Hummer J, Feuer W J
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33136, USA.
Ophthalmology. 1997 Dec;104(12):2053-60; discussion 2060-1. doi: 10.1016/s0161-6420(97)30059-1.
Retinal detachment complicates the course of cytomegalovirus (CMV) retinitis in nearly 30% of human immunodeficiency virus-infected patients. The study goal was to evaluate laser photocoagulation in the treatment of CMV retinitis-related retinal detachments and retinal tears.
Nonrandomized, observational cohort study.
Sixty-three patients with CMV retinitis-related retinal detachments and nine patients with peripheral retinal tears in eyes with CMV retinitis were studied.
Of the 63 eyes with retinal detachment, 23 patients were treated with demarcating laser photocoagulation, 24 patients underwent vitrectomy with silicone oil, and 16 patients were observed without treatment. All nine patients with peripheral retinal tears received laser photocoagulation.
Time to progression of retinal detachment, final visual acuity, and need for vitrectomy surgery were studied.
Median time to progression of the retinal detachment in the laser-treated patients was 175 days versus 39 days in observed patients (P = 0.012). Both initial (P < 0.001) and final (P = 0.005) visual acuities were better in the patients with laser-treated detachment than in the observed or vitrectomy patients. The retinal detachment groups were comparable in follow-up, zone and location of detachment, and size of holes, but the vitrectomy and observed groups had more cases with extensive CMV retinitis. Vitrectomy surgery was required in 9 of 16 (56%) in the observed group and 7 of 23 (30%) in the laser group. Two of nine patients (22%) who failed to respond to laser treatment for retinal breaks required vitrectomy surgery.
Laser photocoagulation of selected retinal detachments and retinal tears delayed or avoided vitrectomy with silicone oil. It may be an important treatment modality for patients with nonmacular detachments and for those who are receiving local anti-CMV therapy with intravitreal injections or pellets, in whom silicone oil may affect the efficacy of the local treatment.
在近30%的人类免疫缺陷病毒感染患者中，视网膜脱离使巨细胞病毒（CMV）视网膜炎的病程复杂化。本研究的目的是评估激光光凝术治疗CMV视网膜炎相关的视网膜脱离和视网膜裂孔。
非随机观察性队列研究。
研究了63例患有CMV视网膜炎相关视网膜脱离的患者以及9例患有CMV视网膜炎的眼中出现周边视网膜裂孔的患者。
在63只患有视网膜脱离的眼中，23例患者接受了划界激光光凝治疗，24例患者接受了硅油玻璃体切除术，16例患者未接受治疗而进行观察。所有9例周边视网膜裂孔患者均接受了激光光凝治疗。
研究视网膜脱离进展时间、最终视力以及玻璃体切除手术的必要性。
激光治疗组视网膜脱离进展的中位时间为175天，而观察组为39天（P = 0.012）。激光治疗的视网膜脱离患者的初始视力（P < 0.001）和最终视力（P = 0.005）均优于观察组或玻璃体切除组患者。视网膜脱离组在随访、脱离区域和位置以及裂孔大小方面具有可比性，但玻璃体切除组和观察组中广泛CMV视网膜炎的病例更多。观察组16例中有9例（56%）需要进行玻璃体切除手术，激光组23例中有7例（30%）需要进行玻璃体切除手术。9例视网膜裂孔激光治疗无效的患者中有2例（22%）需要进行玻璃体切除手术。
对选定的视网膜脱离和视网膜裂孔进行激光光凝可延迟或避免硅油玻璃体切除术。对于非黄斑区脱离的患者以及正在接受玻璃体内注射或植入物局部抗CMV治疗的患者而言，这可能是一种重要的治疗方式，因为硅油可能会影响局部治疗的疗效。
