Contemporary Management of Complex and Non-Complex Rhegmatogenous Retinal Detachment Due to Giant Retinal Tears.
Contemporary Management of Complex and Non-Complex Rhegmatogenous Retinal Detachment Due to Giant Retinal Tears.
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巨大视网膜裂孔致复杂性和非复杂性孔源性视网膜脱离的现代治疗
DOI：
10.2147/opth.s299762
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Wubben TJ
中科院分区：
文献类型：
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作者：
Li KX;Carducci N;Moinuddin O;Zhou Y;Musch DC;Zacks DN;Besirli CG;Wubben TJ
探讨三级转诊中心孔源性视网膜脱离（RRD）伴巨大视网膜裂孔（GRT）的临床特征和手术结局。一项在密歇根大学W.K.接受初次手术修复的GRT相关RRD的回顾性、非连续干预性病例系列。凯洛格眼科中心2011年1月1日至2020年7月1日。收集临床特征和术前、围手术期和术后数据。47例GRT相关RRD患者的48只眼符合入选标准，包括基线时儿童（12岁以下，N=4，8.3%）、有创伤史（N=20，41.7%）或C级增生性玻璃体视网膜病变（PVR-C）（N=7，14.6%）。中位年龄为46岁（四分位距（IQR）：29岁，范围：4 - 72岁），中位随访时间为28个月（IQR：43个月，范围：3-124个月），83.3%（N=40）的受试者为男性。GRT相关RRD的初次手术修复包括睫状体平坦部玻璃体切除术（PPV）（N=40，83.3%）、巩膜扣带术（SB）（N=1，2.1%）或PPV/SB联合术（N=7，14.6%）。手术方法通常涉及使用全氟化碳液体（N=43，90%）和气体填塞（N=39，81%）。3个月时单次手术解剖成功率（SSAS）为75%（95%CI：60%，85%），2年时为65%（95%CI：47%，78%）。所有48只眼（100%）均获得最终解剖成功。中位视力从术前的20/250提高到最终随访时的20/60，44%（N=20）的患眼术后视力达到20/40或更好。在来自三级转诊中心的该系列中，复杂和非复杂GRT相关RRD最常使用PPV单独治疗、全氟化碳液体和气体填塞，最终解剖和视力结局与其他现代GRT系列相当。
To investigate the clinical features and surgical outcomes of rhegmatogenous retinal detachment (RRD) associated with giant retinal tears (GRTs) at a tertiary referral center. A retrospective, non-consecutive interventional case series of GRT-associated RRDs that underwent primary surgical repair at the University of Michigan W.K. Kellogg Eye Center between January 1, 2011 and July 1, 2020. Clinical characteristics and preoperative, perioperative, and postoperative data were collected. Forty-eight eyes of 47 patients with GRT-associated RRDs met inclusion criteria, including those that were children (under 12 years, N=4, 8.3%), associated with a history of trauma (N=20, 41.7%) or with grade C proliferative vitreoretinopathy (PVR-C) (N=7, 14.6%) at baseline. Median age was 46 years (interquartile range (IQR): 29 years, range: 4 to 72 years), median follow-up was 28 months (IQR: 43 months, range: 3–124 months), and 83.3% (N=40) of subjects were male. Primary surgical repair for GRT-associated RRDs included pars plana vitrectomy (PPV) (N=40, 83.3%), scleral buckle (SB) (N=1, 2.1%), or combined PPV/SB (N=7, 14.6%). Surgical approach commonly involved the use of perfluorocarbon liquid (N=43, 90%) and gas tamponade (N=39, 81%). Single surgery anatomic success (SSAS) was 75% (95% CI: 60%, 85%) at 3 months and 65% (95 CI: 47%, 78%) at 2 years. Final anatomic success was achieved in all 48 eyes (100%). Median visual acuity improved from 20/250 preoperatively to 20/60 at final follow-up, with 44% (N=20) of eyes achieving postoperative visual acuity of 20/40 or better. In this series from a tertiary referral center, both complex and non-complex GRT-associated RRDs were most commonly managed with PPV alone, perfluorocarbon liquid, and gas tamponade with favorable final anatomic and visual outcomes comparable to other modern GRT series.