Strategy for the Management of Complex Retinal Detachments The European Vitreo-Retinal Society Retinal Detachment Study Report 2
Strategy for the Management of Complex Retinal Detachments The European Vitreo-Retinal Society Retinal Detachment Study Report 2
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DOI：
10.1016/j.ophtha.2013.01.056
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发表时间：
2013-09-01
期刊：
影响因子：
13.7
通讯作者：
Ducournau, Didier
中科院分区：
文献类型：
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作者：
Adelman, Ron A.;Parnes, Aaron J.;Ducournau, Didier
目的：研究复杂孔源性视网膜脱离（RRD）的治疗结果。设计：非随机、多中心、回顾性研究。参与者：来自五大洲 48 个国家的 176 名外科医生报告了 7678 例 RRD 的初步手术。方法：报告的数据包括临床表现、修复方法和结果。主要结果指标：视网膜衰竭脱离修复（1 级失败率）、研究结论时剩余的硅油（2 级失败率）以及需要额外的程序来修复脱离（3 级失败率）。结果：本次调查中评估的复杂视网膜脱离的主要类别为：（1）B 级增殖性玻璃体视网膜病变（PVR；n = 917），（2）C-1 级 PVR（n = 637），（3）脉络膜脱离或显着张力过低（n = 578），（4）大或巨大的视网膜撕裂（n = 1167），以及（5）黄斑裂孔（n = 153）。在 B 级 PVR 中，单独使用巩膜带扣治疗时的 1 级失败率高于玻璃体切除术 (P = 0.0017)。在C-1级PVR中，接受玻璃体切除术（有或没有巩膜带扣）治疗的患者与仅接受巩膜扣带治疗的患者之间，1级失败率没有统计学上的显着差异（P = 0.7）。与未接受带扣的玻璃体切除术相比，使用附加带扣的玻璃体切除术的失败率更高（P = 0.007）。对于 B 级或 C-1 级 PVR 患者，气体填塞与硅油填塞之间的 1 级失败率没有统计学上的显着差异。与单独使用巩膜扣带治疗相比，采用玻璃体切除术治疗脉络膜脱离或张力过低的病例的失败率显着降低（P = 0.0015）。与巩膜扣带治疗相比，玻璃体切除术治疗大或巨大视网膜撕裂的失败率也显着降低（P = 7 x 10(-8)）。结论：对于视网膜脱离患者，当存在脉络膜脱离、张力过低、大撕裂或巨大撕裂时，玻璃体切除术是首选手术。对于伴有 PVR 的视网膜脱离，可以考虑用气体或硅油填塞。如果要进行玻璃体切除术，这些数据表明补充扣可能没有帮助。
Objective: To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs).Design: Nonrandomized, multicenter, retrospective study.Participants: One hundred seventy-six surgeons from 48 countries spanning 5 continents reported primary procedures for 7678 RRDs.Methods: Reported data included clinical manifestations, the method of repair, and the outcome.Main Outcome Measures: Failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachments (level 3 failure rate).Results: The main categories of complex retinal detachments evaluated in this investigation were: (1) grade B proliferative vitreoretinopathy (PVR; n = 917), (2) grade C-1 PVR (n = 637), (3) choroidal detachment or significant hypotony (n = 578), (4) large or giant retinal tears (n = 1167), and (5) macular holes (n = 153). In grade B PVR, the level 1 failure rate was higher when treated with a scleral buckle alone versus vitrectomy (P = 0.0017). In grade C-1 PVR, there was no statistically significant difference in the level 1 failure rate between those treated with vitrectomy, with or without scleral buckle, and those treated with scleral buckle alone (P = 0.7). Vitrectomy with a supplemental buckle had an increased failure rate compared with those who did not receive a buckle (P = 0.007). There was no statistically significant difference in level 1 failure rate between tamponade with gas versus silicone oil in patients with grade B or C-1 PVR. Cases with choroidal detachment or hypotony treated with vitrectomy had a significantly lower failure rate versus treatment with scleral buckle alone (P = 0.0015). Large or giant retinal tears treated with vitrectomy also had a significantly lower failure rate versus treatment with scleral buckle (P = 7 x 10(-8)).Conclusions: In patients with retinal detachment, when choroidal detachment, hypotony, a large tear, or a giant tear is present, vitrectomy is the procedure of choice. In retinal detachments with PVR, tamponade with either gas or silicone oil can be considered. If a vitrectomy is to be performed, these data suggest that a supplemental buckle may not be helpful.