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Abstract：
BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes.
METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.
RESULTS: A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).
CONCLUSIONS: PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.
METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.
RESULTS: A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).
CONCLUSIONS: PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.
摘要：
背景：风源性视网膜脱离（RRD）是一种严重的疾病，当视网膜从其下面的视网膜色素上皮脱离时发生。与巨大视网膜撕裂（GRT）相关的RRD是由至少90°或四分之一圆周范围的视网膜撕裂引起的。本范围审查系统地识别和总结了评估GRT相关RRD的外科技术的临床研究。讨论功能和视觉结果以及影响治疗结果的风险因素。
方法：本研究按照系统评价和荟萃分析（PRISMA）指南的首选报告项目进行。PubMed,Scopus,谷歌学者，和SpringerLink数据库中搜索相关论文(从2001年1月到2023年3月)。以英语发表并报告危险因素的研究，管理,和GRT相关RRD的治疗结果纳入综述。结果指标包括解剖成功率，BCVA(logMAR)从基线到最终随访的变化，和不良事件。
结果：共鉴定出11,982篇文章。在标题和摘要审查之后，71项研究被认为符合全文审查的条件。符合资格标准的36项研究被纳入最终审查。确定了四种手术技术：平坦部玻璃体切除术（PPV），联合PPV和巩膜扣带术，单独巩膜扣带术,和气动视网膜固定术。各种类型的填塞,包括气体,硅油,和空气,已被使用。PPV是33.1-100％患者中最常用的手术技术。在单独使用PPV的20项研究中，17与术前PVR有关。此外,据报道，在10项研究中，巩膜扣带术单独或与PPV联合作为治疗选择，2-100％的患者仅经历巩膜扣带，13.6-100％的患者经历了PPV和互补巩膜扣带。通过单次手术实现视网膜复位，无残余填塞，实现了主要解剖成功（PAS）。而最终的解剖成功（FAS）是通过一次以上的手术实现的，没有残留的填塞。报告的单次手术解剖成功率（SSAS）为65.51％至100％。术前最佳矫正视力（BCVA）范围为0.067至2.47logMAR，而术后BCVA为0.08~2.3logMAR。在29项研究中观察到视力的改善。白内障（3.9-28.3%）是最常见的术后并发症，其次是高眼压（0.01-51.2%）和PVR（0.8-31.57%）。
结论：PPV是最常见的外科技术，并且目前通常采用微切口玻璃体切除术(MIVS)系统。硅油是RRD修复中最常用的填塞剂。GRT相关RRD的危险因素包括年龄，性别,镜头状态,高度近视状态,增生性玻璃体视网膜病变(PVR),呈现视力，GRT和视网膜脱离的程度，和黄斑受累。未来的研究领域包括减少手术方法报告变异性的指南。填塞物的选择,并报告功能和视觉结果，以告知GRT相关RRD的最佳治疗干预措施。
方法：本研究按照系统评价和荟萃分析（PRISMA）指南的首选报告项目进行。PubMed,Scopus,谷歌学者，和SpringerLink数据库中搜索相关论文(从2001年1月到2023年3月)。以英语发表并报告危险因素的研究，管理,和GRT相关RRD的治疗结果纳入综述。结果指标包括解剖成功率，BCVA(logMAR)从基线到最终随访的变化，和不良事件。
结果：共鉴定出11,982篇文章。在标题和摘要审查之后，71项研究被认为符合全文审查的条件。符合资格标准的36项研究被纳入最终审查。确定了四种手术技术：平坦部玻璃体切除术（PPV），联合PPV和巩膜扣带术，单独巩膜扣带术,和气动视网膜固定术。各种类型的填塞,包括气体,硅油,和空气,已被使用。PPV是33.1-100％患者中最常用的手术技术。在单独使用PPV的20项研究中，17与术前PVR有关。此外,据报道，在10项研究中，巩膜扣带术单独或与PPV联合作为治疗选择，2-100％的患者仅经历巩膜扣带，13.6-100％的患者经历了PPV和互补巩膜扣带。通过单次手术实现视网膜复位，无残余填塞，实现了主要解剖成功（PAS）。而最终的解剖成功（FAS）是通过一次以上的手术实现的，没有残留的填塞。报告的单次手术解剖成功率（SSAS）为65.51％至100％。术前最佳矫正视力（BCVA）范围为0.067至2.47logMAR，而术后BCVA为0.08~2.3logMAR。在29项研究中观察到视力的改善。白内障（3.9-28.3%）是最常见的术后并发症，其次是高眼压（0.01-51.2%）和PVR（0.8-31.57%）。
结论：PPV是最常见的外科技术，并且目前通常采用微切口玻璃体切除术(MIVS)系统。硅油是RRD修复中最常用的填塞剂。GRT相关RRD的危险因素包括年龄，性别,镜头状态,高度近视状态,增生性玻璃体视网膜病变(PVR),呈现视力，GRT和视网膜脱离的程度，和黄斑受累。未来的研究领域包括减少手术方法报告变异性的指南。填塞物的选择,并报告功能和视觉结果，以告知GRT相关RRD的最佳治疗干预措施。
