Azen S P, Scott I U, Flynn H W, Lai M Y, Topping T M, Benati L, Trask D K, Rogus L A
Department of Preventive Medicine, University of Southern California, Los Angeles 90033, USA.
Ophthalmology. 1998 Sep;105(9):1587-97. doi: 10.1016/S0161-6420(98)99023-6.
This study aimed to report anatomic and visual acuity outcomes and complications after 1000-centistoke silicone oil was used as a retinal tamponade for the treatment of complex retinal detachments.
Prospective observational multicenter study conducted at community and university-based ophthalmology clinics.
The study cohort consisted of 2439 patients (2573 eyes) treated for complex retinal detachments associated with cytomegalovirus (CMV) necrotizing retinitis or a non-CMV etiology, including proliferative diabetic retinopathy, giant retinal tears, proliferative vitreoretinopathy, or ocular trauma.
Vitrectomy surgery was performed for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade.
Anatomic outcomes were complete retinal attachment and macular attachment. Visual acuity outcomes were ambulatory vision (> or = 4/200) and preservation of preoperative visual acuity. Complications were rates of secondary intraocular pressure elevation (> or = 30 mmHg), hypotony (< or = 5 mmHg), corneal opacification (including band keratopathy, corneal edema, and corneal abrasions), oil emulsification, and cataract. Outcomes were assessed 6, 12, and 24 months after surgery.
At the 6-month examination, the retina was completely attached in 178 (78%) of 228 CMV eyes and in 855 (70%) of 1219 non-CMV eyes. The macula was attached in 216 (95%) of 228 and 1062 (89%) of 1189 CMV and non-CMV eyes, respectively. Ambulatory vision was noted in 151 (65%) of 234 CMV eyes and in 480 (38%) of 1251 non-CMV eyes. Visual acuity was preserved in 106 (46%) of 230 and 1035 (84%) of 1229 CMV and non-CMV eyes, respectively. The corresponding rates of complications for CMV and non-CMV eyes were: elevated intraocular pressure, 0 (0%) of 196 and 35 (3%) of 1196; hypotony, 11 (6%) of 196 and 228 (19%) of 1196; corneal opacity, 13 (6%) of 229 and 326 (26%) of 1248; emulsification, 3 (1%) of 211 and 29 (3%) of 959; and cataract in phakic eyes, 118 (64%) of 185 and 50 (63%) of 80.
Retinal reattachment was achieved in the majority of eyes using vitrectomy and silicone oil retinal tamponade. Complication rates generally were less frequent in CMV eyes, but follow-up was shorter in this group of patients, largely because of reduced life expectancy. Cataract frequently developed in phakic eyes of study patients. Use of 1000-centistoke silicone oil can be considered in the management of complex retinal detachments associated with multiple etiologies.
本研究旨在报告将1000厘沲硅油用作视网膜填塞物治疗复杂性视网膜脱离后的解剖学和视力结果及并发症。
在社区和大学眼科诊所进行的前瞻性观察性多中心研究。
研究队列包括2439例患者（2573只眼），这些患者因与巨细胞病毒（CMV）坏死性视网膜炎相关的复杂性视网膜脱离或非CMV病因接受治疗，包括增殖性糖尿病视网膜病变、巨大视网膜裂孔、增殖性玻璃体视网膜病变或眼外伤。
对复杂性视网膜脱离行玻璃体切除术，以1000厘沲硅油作为视网膜填塞物。
解剖学结果为视网膜完全复位和黄斑复位。视力结果为可走动视力（≥4/200）和术前视力保留情况。并发症为继发性眼压升高（≥30 mmHg）、低眼压（≤5 mmHg）、角膜混浊（包括带状角膜病变、角膜水肿和角膜擦伤）、硅油乳化和白内障的发生率。在术后6、12和24个月评估结果。
在6个月检查时，228只CMV眼中有178只（78%）视网膜完全复位，1219只非CMV眼中有855只（70%）视网膜完全复位。228只CMV眼中有216只（95%）黄斑复位，1189只CMV和非CMV眼中分别有1062只（89%）黄斑复位。234只CMV眼中有151只（65%）达到可走动视力，1251只非CMV眼中有480只（38%）达到可走动视力。230只CMV眼中有106只（46%）视力得以保留，1229只非CMV眼中有1035只（84%）视力得以保留。CMV眼和非CMV眼相应的并发症发生率为：眼压升高，196只眼中0只（0%），1196只眼中35只（3%）；低眼压，196只眼中11只（6%），1196只眼中228只（19%）；角膜混浊，229只眼中13只（6%），1248只眼中326只（26%）；乳化，211只眼中3只（1%），959只眼中29只（3%）；有晶状体眼中白内障，185只眼中118只（64%），80只眼中50只（63%）。
大多数眼通过玻璃体切除术和硅油视网膜填塞实现了视网膜复位。CMV眼的并发症发生率通常较低，但该组患者的随访时间较短，主要是因为预期寿命缩短。研究患者的有晶状体眼中白内障经常发生。在治疗多种病因相关的复杂性视网膜脱离时可考虑使用1000厘沲硅油。
