评估复发性孔源性视网膜脱离(RRD)手术眼的预后,并研究与视觉和解剖结果相关的变量。
回顾,连续病例系列。
最初RRD修复失败的眼睛在2016年1月1日至2020年12月31日期间接受了≥2次RRD修复手术。
接受≥2次RRD修复的眼睛的回顾性分析。除RRD以外有视网膜脱离病因的眼睛,既往玻璃体视网膜手术,和增殖性糖尿病视网膜病变被排除.使用Tukey诚实地进行显着差异测试的单向方差分析和多变量回归分析来评估统计显著性。
术后时间间隔和最终随访时的解剖成功率和习惯性最佳记录视力(VA)。
在5年内接受原发性RRD修复的眼睛的单次手术成功率(SOSR)为92.4%(2187只眼中的2021只)。本研究包括原发性RRD修复失败的其余166只眼(164例患者)。尽管第二次和第三次RRD修复后的解剖成功率低于SOSR(71.7%和68.1%,分别),接受≥2RRD修复的眼睛之间的最终解剖成功率没有显着差异(范围,90.6%-100%)(P>0.05),在95.8%的眼睛中实现了最终的解剖成功。术后时间间隔和最终随访的平均VA随着RRD修复总数的增加而降低。与接受八氟丙烷和六氟化硫气体的眼睛相比,在第二次RRD修复期间接受硅油内填充剂的眼睛需要第三次RRD修复的可能性降低20.3%(P=0.03)和38.4%(P=0.04)。分别。由于增殖性玻璃体视网膜病变(PVR)(n=43)而发生第三次RRD的眼睛需要第四次RRD修复的可能性比由于新的撕裂或无法重新附着而发生第三次RRD的眼睛高110%(n=4)(P=0.04)。
在本系列中,当RRD需要多次再次手术时,每次手术后的解剖成功率均一致.VA随着RRD维修总数的增加而减少,内填充剂的选择可能会影响额外再次手术的风险。增生性玻璃体视网膜病变是RRD复发的重要预后因素。
To assess outcomes among eyes undergoing surgery for recurrent
rhegmatogenous retinal detachment (RRD) and investigate variables that correlate with visual and anatomic outcomes.
Retrospective, consecutive case series.
Eyes in which initial RRD repair failed that underwent ≥2 surgeries for RRD repair between January 1, 2016, and December 31, 2020.
A retrospective analysis of eyes that underwent ≥2 RRD repairs. Eyes with etiologies of retinal detachment other than RRD, previous vitreoretinal surgery, and proliferative diabetic retinopathy were excluded. One-way analysis of variance with Tukey honestly significant difference testing and multivariate regression analyses were used to assess statistical significance.
Anatomic success rate and habitual best recorded visual acuity (VA) at postoperative time intervals and at final follow-up.
The single-operation success rate (SOSR) among eyes that underwent primary RRD repair over a 5-year period was 92.4% (2021 of 2187 eyes). The remaining 166 eyes (164 patients) in which primary RRD repair failed were included in this study. Although the anatomic success rates after the second and third RRD repairs were lower than the SOSR (71.7% and 68.1%, respectively), the final anatomic success rates did not significantly differ between eyes that underwent ≥2 RRD repairs (range, 90.6%-100%) (P > 0.05), and final anatomic success was achieved in 95.8% of the eyes. The average VA at both postoperative time intervals and final follow-up decreased with an increased total number of RRD repairs. Eyes that received silicone oil endotamponade during the second RRD repair were 20.3% (P = 0.03) and 38.4% (P = 0.04) less likely to require a third RRD repair compared with eyes that received octafluoropropane and sulfur hexafluoride gases, respectively. Eyes that developed a third RRD due to proliferative vitreoretinopathy (PVR) (n = 43) were 110% more likely to require a fourth RRD repair than eyes that developed a third RRD due to a new tear or failure to reattach (n = 4) (P = 0.04).
In this series, the rates of anatomic success appeared consistent after each surgery when multiple reoperations were required for RRD. The VA decreased with an increased total number of RRD repairs, and the endotamponade choice might have affected the risk of additional reoperations. Proliferative vitreoretinopathy was a significant prognostic factor for RRD recurrence.