Silicone oil in the repair of complex retinal detachments - A prospective observational multicenter study
Silicone oil in the repair of complex retinal detachments - A prospective observational multicenter study
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DOI：
10.1016/s0161-6420(98)99023-6
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发表时间：
1998-09-01
期刊：
影响因子：
13.7
通讯作者：
Rogus, LA
中科院分区：
文献类型：
--
作者：
Azen, SP;Scott, IU;Rogus, LA
目的：本研究旨在报告1000厘司硅油作为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以及并发症。设计：在社区和大学眼科诊所进行的前瞻性观察性多中心研究。参与者：研究队列包括2439例患者（2573只眼）治疗与巨细胞病毒（CMV）坏死性视网膜炎或非CMV病因相关的复杂性视网膜脱离，包括增生性糖尿病视网膜病变、巨大视网膜裂孔、增生性玻璃体视网膜病变或眼外伤。干预措施：对复杂性视网膜脱离进行玻璃体切除术，并使用1000-centistoke硅油作为视网膜填充物。主要结果测量：解剖结果为完全视网膜附着和黄斑附着。视力结果为动态视力术后并发症为继发性眼压升高（大于或等于30 mmHg），张力减退（小于或等于5 mmHg），角膜混浊（包括带状角膜病变、角膜水肿和角膜擦伤）、油乳化和白内障，在术后6、12和24个月评估结果。6个月检查时，228只CMV眼中有178只（78%）视网膜完全附着，1219只非CMV眼中有855只（70%）视网膜完全附着。228只CMV和1189只非CMV眼中分别有216只（95%）和1062只（89%）黄斑附着。234只CMV眼中有151只（65%）观察到动态视力，1251只非CMV眼中有480只（38%）观察到动态视力。CMV和非CMV的1229只眼睛中，分别有106/230（46%）和1035/1229（84%）的视力得以保留。巨细胞病毒眼和非巨细胞病毒眼的相应并发症发生率分别为：眼内压升高，196例中0例（0%），1196例中35例（3%）;张力减退，196例中11例（6%），1196例中228例（19%），角膜混浊，229例中13例（6%），1248例中326例（26%）;有晶状体眼185眼118眼（64%），80眼50眼（63%）。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经常发生白内障。在与多种病因相关的复杂视网膜脱离的治疗中，可考虑使用1000厘沲硅油。
Objective: 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.Design: Prospective observational multicenter study conducted at community and university-based ophthalmology clinics.Participants: 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.Intervention: Vitrectomy surgery was performed for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade.Main Outcome Measures: Anatomic outcomes were complete retinal attachment and macular attachment. Visual acuity outcomes were ambulatory vision (greater than or equal to 4/200) and preservation of preoperative visual acuity, Complications were rates of secondary intraocular pressure elevation (greater than or equal to 30 mmHg), hypotony (less than or equal to 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.Results: 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.Conclusions: 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.