Long-Term Safety and Efficacy of Limited Vitrectomy for Vision Degrading Vitreopathy Resulting from Vitreous Floaters
Long-Term Safety and Efficacy of Limited Vitrectomy for Vision Degrading Vitreopathy Resulting from Vitreous Floaters
复制标题
DOI：
10.1016/j.oret.2018.03.011
复制
发表时间：
2018-09-01
影响因子：
4.5
通讯作者：
Nguyen-Cuu, Jeannie
中科院分区：
文献类型：
--
作者：
Sebag, J.;Yee, Kenneth M. P.;Nguyen-Cuu, Jeannie
目的：玻璃体漂浮物可引起视力下降和对比敏感度功能下降。有限的玻璃体切除术可以改善视力，使脑脊液正常化，但是缺乏大规模的客观定量结果测量的长期结果。设计图：案例系列：将145例患者（87例男性，年龄= 57.6 +/- 4.3岁; 58例女性，年龄= 61.5 +/- 12.0岁）的195只眼睛与70例年龄匹配的对照组进行比较。单纯玻璃体后脱离（PVD）是96/195例的原因单纯近视性玻璃体病变30例（49.2%）15.4%，其中56/195眼的原因为玻璃体视网膜病变13/195眼为星状玻璃体变性方法：对有晶状体眼行25 G玻璃体切割术，保留晶状体后3 ~ 4 mm玻璃体，不行PVD。平均随访32.6 ± 23.5个月（范围，3-115个月），144只眼2年或以上，69只眼3年或以上，51只眼4年或以上，24只眼5年或以上。主要结局指标：结果：术后玻璃体回声密度较术前降低94.1%（P < 0.0001），VFQ较术前提高19.3%（P <0.0001）。术前VA为0.68 ± 0.21，术后改善至0.77 ± 0.19（P < 0.0001）。与对照组相比，术前CSF降低了91.3%（P < 0.0001），在术后1、3、6、12、24、36和48个月恢复正常（均P < 0.00005）。无眼内炎病例。3例视网膜裂孔和3例视网膜脱离均成功修复。2例患者发生临床显著的玻璃体出血，自发清除。2例黄斑皱褶和4例复发性飞蚊经再次手术治愈。白内障手术发生在21 124例（16.9%，平均年龄，64 +/- 7岁，没有小于53岁），平均13.1 +/- 6.8个月后，玻璃体切除术。结论：有限的玻璃体切除术的视力退化性玻璃体病降低玻璃体回声密度，改善病人的福祉，提高VA，并恢复正常的CSF。长期疗效和安全性特征表明，这可能是一种安全有效的治疗临床上显着的玻璃体飞蚊症，证实了一项前瞻性随机试验。(C)2018年美国眼科学会
Purpose: Vitreous floaters can lower visual acuity (VA) and degrade contrast sensitivity function (CSF). Limited vitrectomy improves VA and normalizes CSF, but long-term results in a large series with objective quantitative outcome measures are lacking. Design: Case series.Participants: One hundred ninety-five eyes of 145 patients (87 men, age = 57.6 +/- 4.3 years; 58 women, age = 61.5 +/- 12.0 years) reporting bothersome vitreous floaters were compared to 70 age-matched controls. Posterior vitreous detachment (PVD) alone was the cause in 96/195 (49.2%), myopic vitreopathy alone was the cause in 30/195 (15.4%), PVD with myopic vitreopathy was the cause in 56/195 (28.7%), and asteroid hyalosis was the cause in 13/195 eyes (6.7%).Methods: Limited vitrectomy with 25-gauge instruments was performed without surgical PVD induction, preserving 3 to 4 mm of retrolental vitreous in phakic eyes. Follow-up averaged 32.6 +/- 23.5 months (range, 3-115 months), with 2 years or more in 144 eyes, 3 years or more in 69 eyes, 4 years or more in 51 eyes, and 5 years or more in 24 eyes. Main Outcome Measures: Visual acuity, 39-item National Eye Institute Visual Function Questionnaire (VFQ) results, CSF (Weber index), and quantitative ultrasonography results.Results: After surgery, vitreous echodensity decreased by 94.1% (P < 0.0001) and VFQ results improved by 19.3% (P < 0.0001). Preoperative VA was 0.68 +/- 0.21, improving to 0.77 +/- 0.19 after surgery (P < 0.0001). Preoperative CSF was degraded by 91.3% compared with controls (P < 0.0001), normalizing at 1, 3, 6, 12, 24, 36, and 48 months after surgery (P < 0.00005 for each). There were no cases of endophthalmitis. There were 3 retinal tears and 3 retinal detachments that underwent successful repair. Clinically significant vitreous hemorrhage developed in 2 patients, clearing spontaneously. Two macular puckers and 4 recurrent floaters from new PVD were cured by re-operation. Cataract surgery occurred in 21 of 124 patients (16.9%; mean age, 64 +/- 7 years; none younger than 53 years), an average of 13.1 +/- 6.8 months after vitrectomy.Conclusions: Limited vitrectomy for Vision Degrading Vitreopathy decreases vitreous echodensity, improves patient well-being, improves VA, and normalizes CSF. The long-term efficacy and safety profiles suggest this may be a safe and effective treatment for clinically significant vitreous floaters, warranting a prospective randomized trial. (C) 2018 by the American Academy of Ophthalmology