背景:增生性玻璃体视网膜病变(PVR)是复发性视网膜脱离的主要原因。前PVR可导致复发性视网膜脱离,并且在常规的平坦部玻璃体切除术中通常难以去除。这项研究的目的是报告单内窥镜辅助的平坦部玻璃体切除术(E-PPV)在与前增生性玻璃体视网膜病变和上皮膜相关的牵拉性视网膜脱离患者中的手术效果。
方法:回顾性回顾2017年至2021年在三级转诊中心的E-PPV。纳入标准包括接受E-PPV治疗的成人患者,这些患者因牵拉性视网膜脱离伴PVR前膜和内胚膜。数据收集包括患者的人口统计学,眼科检查结果,和手术结果。使用0.05的p值作为统计显著性的阈值进行一系列独立样本比例测试。
结果:55例接受E-PPV的患者中有18例符合纳入标准。有6名女性(33%)和12名男性(p值=0.096)。年龄在27至82岁之间(平均年龄52.1±17.3岁)。9例患者(50%)有同侧视网膜脱离修复史。3个月后单次E-PPV成功率为100%,和94.4%的最新跟进访问。1例患者术后4个月发生复发性视网膜脱离伴后部PVR。57%(8/14)的白内障患者进展,63%(5/8)的患者在术后第一年内接受了白内障摘除手术。
结论:E-PPV能使上皮膜和前PVR可视化和去除。在最近一次随访中,单次E-PPV成功率仍然很高。E-PPV能够在所有研究患者中保留有晶状体晶状体。需要对E-PPV在视网膜手术中的作用进行更大规模的前瞻性研究。
BACKGROUND: Proliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes.
METHODS: Retrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients\' demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance.
RESULTS: Eighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year.
CONCLUSIONS: E-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.