VITRECTOMY FOR FLOATERS Prospective Efficacy Analyses and Retrospective Safety Profile
VITRECTOMY FOR FLOATERS Prospective Efficacy Analyses and Retrospective Safety Profile
复制标题
DOI：
10.1097/iae.0000000000000065
复制
发表时间：
2014-06-01
影响因子：
3.3
通讯作者：
Sadun, Alfredo A.
中科院分区：
文献类型：
--
作者：
Sebag, Jerry;Yee, Kenneth M. P.;Sadun, Alfredo A.
目的：飞蚊症影响视力，但机制尚不清楚。我们假设飞蚊症会降低对比敏感度功能，这可以通过玻璃体切除术使其正常化，并且微创玻璃体切除术将降低视网膜撕裂（据报告为 30%）和白内障（50-76%）的发生率。 方法：在 2 项独立研究中对 76 只患有飞蚊症的眼睛（34 只晶状体眼患者）进行了评估。飞蚊症的病因主要是 76 只眼中的 61 只眼 (80%) 为后玻璃体脱离，76 只眼中的 24 只眼 (32%) 为近视玻璃体病。微创25G玻璃体切除术无需诱导后玻璃体脱离，保留前玻璃体，并使用非空心探针提取套管。通过弗莱堡视力对比测试（韦伯指数 [% W] 重现性 = 92.1%）和国家眼科研究所视觉功能问卷，对 16 例飞蚊症病例进行了前瞻性（长达 9 个月）的疗效研究。对另外 60 例平均随访 17.5 个月（范围 3-51 个月）的安全性进行了单独评估。结果：飞蚊症的对比敏感度功能衰减为 67%（4.0 +/- 2.3 % W；对照受试者 = 2.4 +/- 0.9 % W，P < 0.013）。玻璃体切除术后，每个病例的对比敏感度功能在 1 周时恢复正常（2.0 +/- 1.4 % W，P < 0.01），并在 1 个月（2.0 +/- 1.0 % W，P < 0.003）和 3 个月至 9 个月时保持正常（2.2 +/- 1.5 % W，P < 0.018）。飞蚊症患者的视功能问卷调查（73.2 +/- 15.6，N = 16）比年龄匹配的对照组（93.9 +/- 8.0，N = 12，P < 0.001）低28.3％，术后改善了29.2％（P < 0.001）。在对 60 例接受玻璃体切除术治疗的飞蚊症病例进行的安全性研究中，平均随访 17.5 个月后，没有一人出现视网膜破裂、感染或青光眼。玻璃体切除术后平均 15 个月，34 例中只有 8 例 (23.5%) 需要进行白内障手术（年龄均不小于 53 岁）。 结论：飞蚊症对比敏感度功能较低，玻璃体切除术后对比敏感度功能正常化。视觉功能问卷量化了满意度的改善。不引起玻璃体后脱离可将视网膜撕裂发生率从 30% 降低至 0% (P < 0.007)。玻璃体切除术后白内障发生率从 50% 降低至 23.5% (P < 0.02)。因此，这种方法在减轻飞蚊症引起的视觉功能障碍方面似乎有效且安全。
Purpose: Floaters impact vision but the mechanism is unknown. We hypothesize that floaters reduce contrast sensitivity function, which can be normalized by vitrectomy, and that minimally invasive vitrectomy will have lower incidences of retinal tears (reported at 30%) and cataracts (50-76%).Methods: Seventy-six eyes (34 phakic) with floaters were evaluated in 2 separate studies. Floater etiologies were primarily posterior vitreous detachment in 61 of 76 eyes (80%) and myopic vitreopathy in 24 of 76 eyes (32%). Minimally invasive 25G vitrectomy was performed without posterior vitreous detachment induction, leaving anterior vitreous, and using nonhollow probes for cannula extraction. Efficacy was studied prospectively (up to 9 months) in 16 floater cases with Freiburg Acuity Contrast Testing (Weber index [% W] reproducibility = 92.1%) and the National Eye Institute Visual Function Questionnaire. Safety was separately evaluated in 60 other cases followed up on an average of 17.5 months (range, 3-51 months).Results: Floater eyes had 67% contrast sensitivity function attenuation (4.0 +/- 2.3 % W; control subjects = 2.4 +/- 0.9 % W, P < 0.013). After vitrectomy, contrast sensitivity function normalized in each case at 1 week (2.0 +/- 1.4 % W, P < 0.01) and remained normal at 1 month (2.0 +/- 1.0 % W, P < 0.003) and 3 months to 9 months (2.2 +/- 1.5 % W, P < 0.018). Visual Function Questionnaire was 28.3% lower in floater patients (73.2 +/- 15.6, N = 16) than in age-matched control subjects (93.9 +/- 8.0, N = 12, P < 0.001), and post-operatively improved by 29.2% (P < 0.001). In the safety study of 60 floater cases treated with vitrectomy, none developed retinal breaks, infection, or glaucoma after a mean follow-up of 17.5 months. Only 8 of 34 cases (23.5%) required cataract surgery (none younger than 53 years) at an average of 15 months postvitrectomy.Conclusion: Floaters lower contrast sensitivity function, which normalizes after vitrectomy. Visual Function Questionnaire quantified improvement in satisfaction. Not inducing posterior vitreous detachment reduced retinal tear incidence from 30% to 0% (P < 0.007). Postvitrectomy cataract incidence was reduced from 50% to 23.5% (P < 0.02). This approach thus seems effective and safe in alleviating the visual dysfunction induced by floaters.