rhegmatogenous retinal detachments

  • 文章类型: Journal Article
    目的:描述诱发因素,临床课程,以及小儿孔源性视网膜脱离(RRD)的手术方法,并确定影响解剖成功的因素。方法:回顾性分析2004年1月1日至2020年6月31日因RRD进行手术修复的18岁以下患者的资料,并随访至少6个月。结果:该研究评估了94例患者的101只眼。眼睛,90%至少有1个儿科RRD的诱发因素,包括创伤(46%),近视(41%),既往眼内手术(26%),和先天性异常(23%);81%的患者出现黄斑脱落,34%的患者出现增生性玻璃体视网膜病变(PVR)C级或更严重。PVRC级或更差的存在(P=.0002),总RRD(P=.014),首次手术时仅进行玻璃体切除术(P=.0093)与较差的预后相关。在第一次手术中单独使用巩膜扣(SB)的患者的解剖成功率高于单独使用或联合使用SB进行玻璃体切除术的患者(P=0.0002)。在最后一次手术之后,74%的患者实现了解剖成功。讨论:本研究中的大多数病例与4个易患小儿RRD的危险因素中的1个相关。这些患者通常表现为黄斑脱落和PVRC级或更差。大多数患者在使用SB进行手术修复后获得了解剖成功,玻璃体切除术,或组合。
    Purpose: To describe the predisposing factors, clinical course, and surgical methods of pediatric rhegmatogenous retinal detachment (RRD) and determine which factors affect anatomic success. Methods: Data of patients 18 years or younger who had surgical repair for RRD from January 1, 2004, to June 31, 2020, with a minimum of 6 months of follow-up were retrospectively analyzed. Results: The study evaluated 101 eyes of 94 patients. Of the eyes, 90% had at least 1 predisposing factor to pediatric RRD, including trauma (46%), myopia (41%), prior intraocular surgery (26%), and congenital anomaly (23%); 81% had macula-off detachments and 34% had proliferative vitreoretinopathy (PVR) grade C or worse at presentation. The presence of PVR grade C or worse (P = .0002), total RRD (P = .014), and vitrectomy alone at first surgery (P = .0093) were associated with worse outcomes. Patients who had scleral buckle (SB) alone at the first surgery had statistically higher rates of anatomic success than those who had vitrectomy alone or combined with SB (P = .0002). After the final surgery, 74% of patients achieved anatomic success. Discussion: The majority of cases in this study were associated with 1 of the 4 risk factors predisposing to pediatric RRD. These patients often present late with macula-off detachments and PVR grade C or worse. The majority of patients achieved anatomic success after surgical repair using SB, vitrectomy, or a combination.
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  • 文章类型: Journal Article
    目的:评估和比较2015-2019年温州地区孔源性视网膜脱离(RRD)的发生率和特征。
    方法:温州地区居民中所有新出现的RRD病例,从2015年1月至2019年12月,我们从医院记录中回顾性检索.年度人口数据摘自《温州统计年鉴》。
    结果:有3629例合格病例。RRD的平均发生率为7.79例/10万人口(95%置信区间,7.24-8.34),男性和女性的发病率分别为7.99和7.56,分别。年发病率从2015年的7.26例/10万逐渐上升到2019年的10.00例/10万,总体上升37.74%。增长率最高的是60至69岁的年龄组。在2750只具有眼轴长度(AL)数据的眼睛中,1675(60.91%)的AL大于24mm。
    结论:在过去的5年中,温州地区观察到了RRD发病率增加的趋势。
    OBJECTIVE: To estimate and compare the incidence and characteristics of rhegmatogenous retinal detachments (RRDs) in the Wenzhou area in 2015 to 2019.
    METHODS: All newly developed RRD cases among residents of the Wenzhou area, from January 2015 to December 2019, were retrospectively retrieved from hospital records. Annual population data were extracted from the Wenzhou Statistical Yearbook.
    RESULTS: There were 3629 eligible cases. The average incidence of RRD was 7.79 cases per 100 000 population (95% confidence interval, 7.24-8.34), and the incidences were 7.99 and 7.56 for males and females, respectively. The annual incidence increased gradually from 7.26 cases per 100 000 in 2015 to 10.00 cases per 100 000 in 2019, with an overall increase of 37.74%. The highest rate of increase occurred in the age group from 60 to 69 years. Of 2750 eyes with axial length (AL) data, 1675 (60.91%) had an AL greater than 24 mm.
    CONCLUSIONS: A trend to increasing RRD incidence is observed in the Wenzhou area over the past 5-year period.
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  • 文章类型: Journal Article
    目的:与标准手术显微镜(SOM)设置相比,使用三维平视显示器(3DHUD)手术平台评估23号玻璃体视网膜手术治疗孔源性视网膜脱离的疗效和结果。设计:回顾性队列研究。参与者:140例原发性视网膜脱离患者的一百四十只眼。方法:使用3DHUD对所有眼睛进行了23号平面玻璃体切除术,以进行原发性视网膜脱离(NGENUITY;AlconInc.,沃思堡,德州,美国;n=70眼)或SOM设置(n=70眼);在严重白内障的情况下,进行了额外的白内障超声乳化吸除联合人工晶状体(IOL)植入.最少随访2个月。主要指标:原发性视网膜复位率,增生性玻璃体视网膜病变(PVR)的发生率,最佳矫正视力(BCVA),和手术持续时间。结果:3DHUD和SOM组各70只眼。两组在年龄方面没有差异(p=0.70),视网膜脱离程度(p=0.07),视网膜撕裂的数量(p=0.40),黄斑受累(p=0.99),术前BCVA(p=0.99)。术后,3DHUD和SOM在原发性视网膜复位率方面具有可比性(88.6vs.94.3%;p=0.37),术后PVR的发展(12.9%vs.7.1%;p=0.40)和最终BCVA(0.26±0.40vs.0.21±0.38logMAR;p=0.99)。3DHUD组的手术持续时间明显更长(66.2±16.5vs.61.2±17.1分钟;p=0.04),然而,在前35只眼睛的“学习曲线”(p=0.49)后,这种效应消失了。结论:在进行23号玻璃体视网膜手术治疗孔源性视网膜脱离时,使用3DHUD设置可以获得与常规手术显微镜相同的结果,包括原发性视网膜复位率,术后PVR和最终BCVA的发生率。然而,手术的持续时间最初可能会稍长一些3DHUD,表明学习曲线的效果。
    Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting. Design: Retrospective cohort study. Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment. Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY; Alcon Inc., Fort Worth, Texas, USA; n = 70 eyes) or a SOM setting (n = 70 eyes); in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months. Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery. Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%; p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%; p = 0.40) and final BCVA (0.26 ± 0.40 vs. 0.21 ± 0.38 logMAR; p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 ± 16.5 vs. 61.2 ± 17.1 min; p = 0.04), an effect which however vanished after a \"learning curve\" of the first 35 eyes (p = 0.49). Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve.
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