ELECTRONIC MEDICAL RECORD DATABASE STUDY OF VITRECTOMY AND OBSERVATION FOR VITREOMACULAR TRACTION
ELECTRONIC MEDICAL RECORD DATABASE STUDY OF VITRECTOMY AND OBSERVATION FOR VITREOMACULAR TRACTION
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玻璃体切除术电子病历数据库研究及玻璃体黄斑牵引观察
DOI：
10.1097/iae.0000000000001012
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
R. Johnston
中科院分区：
文献类型：
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作者：
Timothy L. Jackson;P. Donachie;R. Johnston
目的：审查玻璃体黄斑牵引的自然史，以及手术的风险和益处。方法：对来自16个英国玻璃体视网膜单位的1，254例（1，399眼）玻璃体黄斑牵引患者进行数据库研究。结果：中位年龄为75岁，36.2%的患者被诊断为糖尿病。在986只（70.5%）保守治疗的患眼中，最小分辨角视力的中位对数为0.30（Snellen 20/40），在随访期间保持不变。在413只眼（29.5%）需要行睫状体平坦部玻璃体切除术的患者中，术后6个月至12个月，中位术前视力从0.60提高至0.50（20/80-20/63），33%的患者至少获得0.3个单位（约2 Snellen线）。玻璃体切除术联合内界膜剥离术43.8%，视网膜前膜剥离术42.4%，气体/空气填充术46.2%，白内障手术27.9%。12.6%发生了一种或多种术中并发症;最常见的是视网膜裂孔（8.0%）、视网膜创伤（1.9%）和视网膜出血（1.0%）。术后视网膜脱离发生率为2.7%，黄斑裂孔发生率为2.2%。玻璃体切除术后1、2、3年白内障手术率分别为28.2%、38.2%、42.7%。结论：玻璃体黄斑牵引术后视力稳定者占多数。那些进展到玻璃体切除术有相对适度的视力增益，并发症并不罕见。
Purpose: To audit the natural history of vitreomacular traction, and the risks and benefits of surgery. Methods: Database study of 1,254 patients (1,399 eyes) with vitreomacular traction from 16 UK vitreoretinal units. Results: The median age was 75 years, with 36.2% of patients diagnosed as diabetic. In 986 (70.5%) eyes managed conservatively, the median presenting logarithm of the minimum angle of resolution visual acuity of 0.30 (Snellen 20/40) was unchanged over follow-up. Of 413 eyes (29.5%) that required pars plana vitrectomy, the median preoperative visual acuity improved from 0.60 to 0.50 (20/80–20/63), 6 months to 12 months after surgery, with 33% gaining at least 0.3 units (approximately 2 Snellen lines). Vitrectomy was combined with internal limiting membrane peel in 43.8%, epiretinal membrane peel in 42.4%, gas/air tamponade in 46.2%, and cataract surgery in 27.9%. One or more intraoperative complications occurred in 12.6%; most commonly retinal breaks (8.0%), retinal trauma (1.9%), and retinal hemorrhage (1.0%). Postoperative retinal detachment occurred in 2.7% and macular hole in 2.2%. The 1, 2, and 3 year rates of postvitrectomy cataract surgery were 28.2%, 38.2%, and 42.7%, respectively. Conclusion: Many eyes with vitreomacular traction have stable visual acuity. Those progressing to vitrectomy have relatively modest visual acuity gains, and complications are not infrequent.