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硅油填充的玻璃体视网膜手术治疗原发性单纯性孔源性视网膜脱离:临床效果及其并发症

Antoun J, Azar G, Jabbour E, et al.

期刊名称:Retina

卷期:2016年第36卷第10期

摘要

背景:本研究旨在确定硅油(SO)填充的平坦部玻璃体切除手术(PPV)治疗原发性单纯性孔源性视网膜脱离后的解剖和功能结果以及可能出现的并发症。研究方法:本研究是一项前瞻性观察研究。我们对62名在2006年1月1日和2012年4月30日之间接受SO填充的PPV手术修复原发性单纯性孔源性视网膜脱离的患者进行了随访。总体而言,当患者存在明显白内障或玻璃体出血症状而阻碍眼底充分可视化时才选择PPV手术替代巩膜扣带术。对于生活在海拔1000米以上的患者,由于SF6或C3F8填充存在急性眼内压(IOP)升高的风险,选择硅油来替代气体填充。所有患者眼都采用1000厘沲的SO填注。在对所有患者的随访中,我们对每位患者的眼病史进行详细了解并深入评价双侧眼,包括最佳矫正视力、眼前段检查、压平式眼压计测量的IOP以及眼底检查。接下来对患者术后第1天,第1周,第1个月,第3个月,第6个月,以及每6个月的结果进行评估。IOP升高即IOP超过21mmHg。研究结果:主要观察指标为解剖成功率、最终的最佳矫正视力、IOP升高、白内障形成,及其他并发症。研究对象为采用PPV和SO填充进行视网膜脱离修复的62名患者的62只眼(其中41名男性和21名女性)。患者实施手术时的年龄为57.6±10.5年(平均±标准偏差;范围,34-79岁)。所有患者均为白人。平均随访时间为24.5±17.3个月(范围, 6-70个月)。移除SO6个月后视网膜复位的解剖成功率为93.5%。有55只眼的最终BCVA提高(88.7%),平均增益为4行Snellen线,5只眼的最终BCVA没有变化(8.1%),2只眼的最终BCVA变差(3.2%),平均降低3行Snellen线。SO填充的平均持续时间为5.12±2.37个月(范围,2-12个月)。玻璃体切除术后仍然为有晶状体的30只眼中有24只眼(80.0%)在7.37±3.00个月后接受白内障手术(范围,2-13个月)。随访期间有35只眼(56.5%)的IOP升高。31名患者在术后即刻期(1个月)具有短暂性高眼压症状,并且需要局部治疗。只有1只眼(2.9%)需要采取过滤引流术来控制IOP。没有患者眼发生继发于IOP升高的视神经病变。研究结论:SO填充的平坦部玻璃体切除手术是一种治疗生活在高海拔地区(>1000m)的原发性单纯性孔源性视网膜脱离患者的安全且高效的手术方式。另外,在我们的研究中PPV和SO注射物与良好的解剖和功能结果相关。视网膜脱离的复位率高,而增生性玻璃体视网膜病变的几率则较低。白内障形成和IOP升高较为常见但可以成功地控制其并发症。

BACKGROUND:To determine the anatomical and functional outcomes and possible complications after pars plana vitrectomy (PPV) with silicone oil (SO) tamponade in primary uncomplicated rhegmatogenous retinal detachments.METHODS:This is a prospective observational study. Overall, 62 consecutive patients who underwent surgical repair by PPV and SO injection for primary uncomplicated rhegmatogenous retinal detachment between January 01, 2006 and April 30, 2012 were followed. In general, PPV was chosen over scleral buckling when a significant cataract or a vitreous hemorrhage prevented adequate fundus visualization. Silicone oil was chosen over gas tamponade in patients living at 1,000 meters above the sea level, where SF6 or C3F8 tamponade could not be performed because of the risk of acute increase of intraocular pressure (IOP). One thousand centistokes SO was used in all eyes. At all visits, patients had a detailed ocular history and thorough bilateral evaluation, including best-corrected visual acuity, anterior segment examination, and IOP measurements by aplanation and fundus examination. Outcomes were assessed at 1 day, 1 week, 1 month, 3 months, 6 months, and every 6 months thereafter. Increased IOP was defined as an IOP of more than 21 mmHg.RESULTS:Anatomical success rate, final best-corrected visual acuity, IOP elevation, cataract formation, and other complications were the main outcome measures. This study included 62 eyes of 62 patients (41 men and 21 women) that underwent retinal detachment repair by PPV and SO injection. The age at the time of intervention was 57.6 ± 10.5 years (mean ± standard deviation; range, 34-79 years). All patients were whites. Mean follow-up was 24.5 ± 17.3 months (range, 6-70 months). Anatomical success rate defined as retinal reattachment 6 months after SO removal was 93.5%. Final BCVA was improved in 55 eyes (88.7%), with a mean of 4 Snellen lines, unchanged in 5 (8.1%), and worse in 2 eyes (3.2%), with a mean of 3 Snellen lines. Mean duration of SO tamponade was 5.12 ± 2.37 months (range, 2-12 months). From the 30 eyes that were still phakic after vitrectomy, 24 eyes (80.0%) underwent cataract surgery within a period of 7.37 ± 3.00 months (range, 2-13 months). Thirty-five eyes (56.5%) had an increase in IOP during the follow-up period. Thirty-one patients had transient ocular hypertension requiring topical treatment during the immediate postoperative period (one month). Only 1 eye (2.9%) required filtrating drainage surgery for IOP control. No eyes developed optic neuropathy secondary to IOP elevation.CONCLUSION:Pars plana vitrectomy with SO injection seems to be a safe and efficient surgical approach in the treatment of primary uncomplicated rhegmatogenous retinal detachment in patients living in high altitude (>1,000 m). Also, PPV and SO injection are associated with good anatomical and functional outcomes in our series. Reattachment rates are high, and rates of proliferative vitreoretinopathy are low. Cataract formation and elevated IOP represent frequent but successfully controlled complications.


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