Vrabec T R
Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Ophthalmology. 1997 Dec;104(12):2062-7. doi: 10.1016/s0161-6420(97)30058-x.
The purpose of the study is to investigate the role of laser photocoagulation in the treatment of macula-sparing cytomegalovirus (CMV)-related retinal detachment (CMVRD) in patients with acquired immune deficiency syndrome (AIDS).
Seven macula-sparing CMVRD identified between July 1995 and February 1997 were managed with laser photocoagulation and observed prospectively (group I). Seven CMVRD reattached with pars plana vitrectomy (PPV) and silicone oil injection (group II) between January 1992 and June 1996 were analyzed retrospectively.
Patients with AIDS with macula-sparing rhegmatogenous CMVRD with no proliferative vitreoretinopathy and visual acuity better than 20/30 were studied.
Demarcation laser photocoagulation (group I) or PPV with silicone oil injection (group II) was performed.
Postoperative best-corrected visual acuity (BCVA), temporary or permanent visual loss, CMVRD progression or recurrence, and cataract were measured.
Follow-up ranged from 2 to 19 months (mean, 9 months) in group I. Post-treatment BCVA was unchanged in all eyes after laser. One retina redetached 9 months after laser treatment. Final visual acuity was less than 20/40 in one eye because of progressive CMV retinitis. Follow-up ranged from 2 to 24 months (mean, 10.4 months) in group II. All group II RDs were reattached successfully with PPV and silicone oil injection. Best-corrected visual acuity was an average of 1.6 lines worse after vitrectomy. Silicone-induced hyperopic shift caused temporary visual loss in all eyes (mean duration, 5.6 weeks). Delayed visual loss due to cataract formation occurred in five eyes. Three eyes had cataract extraction within 6 months. Two partial redetachments developed. One was repaired with repeat vitrectomy. Final visual acuity was less than 20/40 in five of seven eyes because of progressive CMV retinitis (1), dense cataract (2), uncorrected refractive error (2), and uncertain cause (1).
Demarcation laser photocoagulation appears to be an effective treatment for many macula-sparing CMVRD. Loss of BCVA, temporary postoperative visual loss due to silicone-induced refractive error, and delayed visual loss due to cataract after vitrectomy with silicone oil injection may be avoided. Demarcation laser photocoagulation may be an effective alternative to vitrectomy in macula-sparing CMVRD.
本研究旨在探讨激光光凝在获得性免疫缺陷综合征（AIDS）患者中治疗黄斑未累及的巨细胞病毒（CMV）相关性视网膜脱离（CMVRD）的作用。
1995年7月至1997年2月间确诊的7例黄斑未累及的CMVRD患者接受激光光凝治疗并进行前瞻性观察（I组）。回顾性分析1992年1月至1996年6月间7例经玻璃体切割联合硅油注入复位的CMVRD患者（II组）。
研究对象为患有黄斑未累及的孔源性CMVRD、无增殖性玻璃体视网膜病变且视力优于20/30的AIDS患者。
I组行视网膜分界线光凝，II组行玻璃体切割联合硅油注入。
测量术后最佳矫正视力（BCVA）、暂时或永久性视力丧失、CMVRD进展或复发以及白内障情况。
I组随访时间为２至19个月（平均9个月）。激光治疗后所有患眼的治疗后BCVA均未改变。1例视网膜在激光治疗9个月后再次脱离。1例患眼因CMV视网膜炎进展最终视力低于20/40。II组随访时间为2至24个月（平均为10.4个月）。II组所有视网膜脱离均经玻璃体切割联合硅油注入成功复位。玻璃体切割术后最佳矫正视力平均下降1.6行。硅油引起的远视性移位导致所有患眼暂时视力丧失（平均持续时间5.6周）。5例患眼因白内障形成出现延迟性视力丧失。3例患眼在6个月内行白内障摘除术。发生2例部分视网膜再脱离。1例经再次玻璃体切割修复。7例患者中5例患眼最终视力低于20/40，原因分别为CMV视网膜炎进展（1例）、致密性白内障（2例）、未矫正屈光不正（2例）及原因不明（1例）。
视网膜分界线光凝似乎是治疗许多黄斑未累及的CMVRD的有效方法。可避免BCVA丧失、玻璃体切割联合硅油注入术后因硅油引起的屈光不正导致的术后暂时视力丧失以及白内障引起的延迟性视力丧失。视网膜分界线光凝可能是黄斑未累及的CMVRD玻璃体切割术的有效替代方法。
