Han D P, Mohsin N C, Guse C E, Hartz A, Tarkanian C N
Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA.
Am J Ophthalmol. 1998 Nov;126(5):658-68. doi: 10.1016/s0002-9394(98)00181-0.
To compare pneumatic retinopexy and scleral buckling for repair of primary rhegmatogenous retinal detachment with respect to visual outcome, single-procedure reattachment rate, and development of proliferative vitreoretinopathy.
A consecutive series of eyes initially treated with pneumatic retinopexy (n = 56) between March 1986 and February 1996 were compared with a selected group of eyes treated with scleral buckling (n = 86) with similar location and distribution of retinal breaks and absence of proliferative vitreoretinopathy. A regression model was developed to adjust for underlying differences between treatment groups, resulting in a cohort of 50 eyes in each group for final comparison. A minimum follow-up of 6 months was obtained.
Single-procedure reattachment rate was significantly higher for scleral buckle eyes (42 of 50 eyes, 84%) than for pneumatic retinopexy eyes (31 of 50 eyes, 62%; P < or = .01). Correspondingly, reoperation rate was significantly higher for pneumatic retinopexy eyes (19 of 50 eyes, 38%) than for scleral buckle eyes (7 of 50 eyes, 14%; P < or = .01). Multiple regression analysis evaluating perioperative factors demonstrated that the use of pneumatic retinopexy was the sole factor predictive of retinal detachment after a single procedure (relative odds = 2.20, P = .02). Final reattachment rate, after reoperations, was 98% (49 of 50 eyes) in each group. Except for nonphakic eyes, final visual outcome and rate of postoperative proliferative vitreoretinopathy development did not differ significantly between the two procedures.
In phakic eyes, pneumatic retinopexy was associated with a significantly higher reoperation rate than scleral buckling, but resulted in equivalent final visual outcome and reattachment rate after reoperations. If used, it must be incorporated into a strategy in which patient and physician are prepared for a greater chance of reoperation compared to initial management with scleral buckling.
比较气体视网膜固定术和巩膜扣带术治疗原发性孔源性视网膜脱离在视力预后、单次手术复位率以及增殖性玻璃体视网膜病变发生方面的差异。
将1986年3月至1996年2月间最初接受气体视网膜固定术治疗的一系列连续病例（n = 56）与一组经选择的接受巩膜扣带术治疗的病例（n = 86）进行比较，两组病例的视网膜裂孔位置和分布相似且均无增殖性玻璃体视网膜病变。建立回归模型以调整治疗组之间的潜在差异，最终每组各有50只眼用于比较。随访时间至少为6个月。
巩膜扣带术组的单次手术复位率（50只眼中42只，84%）显著高于气体视网膜固定术组（50只眼中31只，62%；P≤0.01）。相应地，气体视网膜固定术组的再次手术率（50只眼中19只，38%）显著高于巩膜扣带术组（50只眼中7只，14%；P≤0.01）。评估围手术期因素的多元回归分析表明，采用气体视网膜固定术是单次手术后视网膜脱离的唯一预测因素（相对比值 = 2.20，P = 0.02）。再次手术后，每组的最终复位率均为98%（50只眼中49只）。除无晶状体眼外，两种手术在最终视力预后和术后增殖性玻璃体视网膜病变发生率方面无显著差异。
在有晶状体眼中，气体视网膜固定术的再次手术率显著高于巩膜扣带术，但再次手术后的最终视力预后和复位率相当。如果采用该方法，必须将其纳入一种策略中，即与最初采用巩膜扣带术治疗相比，患者和医生要为更高的再次手术可能性做好准备。
