背景:比较术中局部和360度激光光凝在23号有限平面玻璃体切除术(PPV)治疗孔源性视网膜脱离(RRD)中的疗效。
方法:本回顾性研究,比较,连续的,介入研究包括155例患者的155只眼,这些患者使用23号PPV进行了RRD的一期修复,随访至少6个月.对医疗记录进行回顾性审查,以及相应的人口统计数据,术前眼科特征,手术管理,记录术后病程。主要结局指标包括单次手术解剖成功,术前和术后视力,和并发症。
结果:83例患者(A组)在PPV中接受了局部激光光凝,其余72例患者(B组)在PPV中接受了圆周360度激光光凝。两个熟练的外科医生做了所有的手术,和23号PPV仪表,广角观察系统,内激光光凝,在每种情况下都使用了气体填塞剂。在基线特征中没有发现显著差异。A组单次手术解剖成功率为96.4%,B组为95.8%,无显著性差异(p=1.00)。原发性解剖失败是由于每组2只眼断裂导致的再脱离引起的(没有新的断裂1只眼,A组新突破1eye,B组2只眼睛没有新的断裂),增殖性玻璃体视网膜病变每组1只眼。其他并发症为视网膜前膜7眼(A组3眼,B组4),B组1眼黄斑裂孔,术前和术后最佳矫正视力(BCVA)和BCVA改善无差异(分别为p=0.144,p=0.866和p=0.263)。
结论:局部激光光凝显示RRD患者的解剖和视觉结果无差异,与有限PPV中的360度激光光凝相比。在没有严重PVR的原发性孔源性视网膜脱离的玻璃体切除术中,可能不需要常规的圆周360度激光光凝。
BACKGROUND: To compare the efficacy of intraoperative localized and 360-degree laser photocoagulation in 23-gauge limited pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).
METHODS: This retrospective, comparative, consecutive, interventional study included 155 eyes of 155 patients who underwent primary repair of RRD utilizing 23-gauge PPV with at least six months of follow up. Medical records were retrospectively reviewed, and the corresponding demographic data, preoperative ophthalmic features, surgical management, and postoperative course were recorded. Main outcome measures included single surgery anatomical success, pre- and post-operative visual acuity, and complications.
RESULTS: Eighty-three patients (group A) received localized laser photocoagulation in PPV, while the remaining 72 patients (group B) received underwent circumferential 360-degree laser photocoagulation in PPV. Two skilled-surgeons performed all the surgeries, and 23-gauge PPV instrumentation, a wide-angle viewing system,
endolaser photocoagulation, and gas tamponade were used in each case. No significant difference was identified in baseline characteristics. The single surgery anatomical success rate was 96.4 % in group A, and 95.8 % in group B, showing no significant difference (p = 1.00). Primary anatomical failure was caused by re-detachment due to break in 2 eyes in each group (no new break 1 eye, new break 1eye in group A, 2 eyes with no new break in group B), and proliferative vitreoretinopathy in 1 eye in each group. Other complications were epiretinal membrane in 7 eyes (3 in group A, 4 in group B), and macular hole in 1 eye in group B. There were no differences in pre- and post-operative best-corrected visual acuity (BCVA) as well as BCVA improvement (p=0.144, p=0.866 and p=0.263, respectively).
CONCLUSIONS: Localized laser photocoagulation showed no difference in anatomic and visual outcome in RRD patients, when compared with 360-degree laser photocoagulation in limited PPV. Routine circumferential 360-degree laser photocoagulation may not be necessary in vitrectomy surgery for primary rhegmatogenous retinal detachment without severe PVR.