Modelling postoperative visual acuity with and without proliferative vitreoretinopathy associated with primary rhegmatogenous retinal detachment

Purpose

To find models that will explain the variability in postoperative visual acuity (VA) (logarithmic: logMAR) associated with unilateral primary rhegmatogenous retinal detachment (RD).

Methods

This was a prospective clinical cohort study of 33 patients with proliferative vitreoretinopathy (PVR: PVR<C3) and 33 without PVR, all of whom were candidates for scleral buckling (SB) surgery. Central retinal artery (CRA) Doppler sonography parameters (peak systolic, end diastolic velocities and resistibility index) and intraocular pressure (IOP) were measured before SB. Immunoreactive endothelin-1 (IR-ET-1) levels in both plasma and subretinal fluid (SRF) were measured using a radioimmunoassay. Visual outcomes were analysed by stepwise multivariate linear regression. The preoperative parameters used in the analysis included RD duration, IOP, logMAR VA, CRA parameters, preoperative plasma levels and intraoperative levels of IR-ET-1 in the SRF.

Results

The models for 8-month-postoperative logMAR VA demonstrated a predictive power higher than 85%. The values of the 8-month-postoperative logMAR VA were as follows: (a) in No PVR= −0.151+0.06 preoperative duration (days), with a predictive power of 85.3% (b) in PVR= −1.071+0.06 SRF IR-ET-1 (pg/ml)+0.459 preoperative logMAR VA explaining 89.9% of the variability in the postoperative logMAR VA.

Conclusions

The duration of RD and the levels of IR-ET-1 in the SRF appear to be the best explanatory variables in the models for 8-month-postoperative logMAR VA variability in RD patients. RD surgery should be performed as soon as possible to best preserve VA.     

復雜視網膜脱離硅油填充后的高眼壓與低眼壓

目的探討復雜性視網膜脱離平坦部玻璃體切割硅油填充后高眼壓與低眼壓的發生和危險因素.方法對62例(66眼)平坦部玻切硅油填充的復雜網脱病例進行隨訪檢查.結果隨訪至1年,高眼壓和低眼壓發生率爲31.82%和15.15%,術后第一天高眼壓與其它隨訪期比較無差异,p＞0.05.增殖性糖尿病視網膜病變和增殖性玻璃體視網膜病變及有青光眼史和糖尿病史與無上述病史的高眼壓發生率有顯著差异,分别爲p＜0.01和p＜0.05.80%術后低眼壓患者術前就存在低眼壓和無晶狀體.結論高眼壓和低眼壓是復雜網脱硅油填充術后的常見許發症,其發生率分别爲31.82%(21眼)和15.15%(10眼),前者的危險因素包括青年眼和糖尿病史及術后第一天高眼壓的發生;術前低眼壓和無晶狀體是后者的危險因素.     

Preoperative duration of retinal detachment and subretinal immunoreactive endothelin-1: repercussion on logarithmic visual acuity

Purpose  

To analyze whether preoperative duration of primary rhegmatogenous retinal detachment (RD) influences endothelin-1 (ET-1)—a vasoactive, mitogenic, and pro-apoptotic peptide- levels with repercussions on logarithmic (LogMAR) visual acuity (VA).     

Retinal detachment and proliferative vitreoretinopathy: ophthalmic artery blood velocities, intraocular pressure, and endothelin-1

PURPOSE: To analyze if endothelin-1 (ET-1) may have an effect on ophthalmic artery (OA) blood flow velocities and intraocular pressure (IOP) in retinal detachment (RD). METHODS: Using radioimmunoassay, immunoreactive (IR) ET-1 levels were tested in both plasma and subretinal fluid (SRF) specimens from patients with RD, while only plasma specimens from normal (healthy) subjects were tested. OA Doppler sonography parameters and IOP were measured in eyes with RD, with and without proliferative vitreoretinopathy (PVR), their respective healthy fellow eyes, and normal eyes. RESULTS: RD eyes had lower OA peak systolic velocity (PSV) and end diastolic velocity (EDV), higher resistivity index (RI), lower IOP, and higher plasma IR ET-1 levels than normal eyes (P < 0.0001). Eyes with PVR had lower OA PSV and EDV, higher RI, lower IOP, higher plasma IR ET-1 levels, and higher SRF IR ET-1 than eyes without PVR (P < 0.0001). A statistically significant linear correlation was found among OA parameters, IOP, and SRF IR ET-1 measurements. CONCLUSIONS: Decreased OA blood flow velocities may explain lower IOP found in RD patients, and ET-1 levels may be responsible for both measurements.     

Prediction of visual outcome after retinal detachment surgery using the Lotmar visometer

AIM: To evaluate whether an achromatic interferometer, the Lotmar visometer, is useful in predicting postoperative visual outcome in patients with primary rhegmatogenous retinal detachment (RD) involving the macula. METHODS: This prospective study included 40 eyes of 40 non-consecutive patients with macula-off RD. The eyes were phakic or pseudophakic, had a clear optical media, and had a measurable potential vision on preoperative visometric examination. Preoperative variables included Snellen visual acuity, duration of macular detachment, extent of RD, and visometric potential acuity. Reattachment surgery consisted of radial scleral buckling in 33 patients, circumferential scleral buckling and encircling in seven patients, and subretinal fluid drainage in 10 patients. Retinal breaks were treated with cryotherapy or laser photocoagulation. Patients were followed up for at least 6 months after uncomplicated surgery. Best corrected visual acuity measured at any time during follow up was correlated with the preoperative variables. RESULTS: Preoperative visual acuity was less than 20/200 in 37 (93%) of 40 patients. Potential visual acuity of 20/200 or better was measured using the Lotmar visometer in 37 patients (93%). Postoperative visual acuity was correlated significantly with duration of macular detachment (r=0.55; p<0.001), and extent of RD approached statistical significance (r=0.31; p=0.05). There was a higher correlation between postoperative visual acuity and the visometric measurements (r=0.61; p<0.001). CONCLUSIONS: The Lotmar visometer may be a valuable method to estimate visual outcome after uncomplicated scleral buckling surgery in patients with RD involving the macula.     

Predictive visual outcome after macula-off retinal detachment surgery using optical coherence tomography

PURPOSE: To determine whether preoperative optical coherence tomography (OCT) is useful in predicting postoperative visual outcome for patients with primary macula-off rhegmatogenous retinal detachment (RD). METHODS: This prospective study included 20 nonconsecutive eyes with macula-off RD and successful reattachment of the retina. Preoperative 5-mm OCT was performed through the center of the fovea. The relationship among preoperative OCT findings, main preoperative clinical variables, and final postoperative visual acuity was statistically analyzed. RESULTS: Final postoperative visual acuity was negatively correlated with three preoperative OCT variables: height of RD at the central fovea (r=0.79; P <0.001), distance from the central fovea to the nearest undetached retina (r=0.75; P <0.00051), and, to a lesser degree, extent of structural changes in the detached retina (r=0.48; P=0.03). Preoperative visual acuity was the only clinical variable statistically correlated with final postoperative visual acuity in this study (r=0.55; P=0.01). Using multivariate logistic regression analyses, the structure of the detached retina combined with the distance from the central fovea to the nearest undetached retina, as determined with OCT, was highly correlated with final postoperative visual acuity (r=0.82; P <0.000051). CONCLUSION: Preoperative macular analysis with OCT may help to predict visual outcome for patients with macula-off RD.     

Comparative study of incomplete posterior vitreous detachment as a risk factor for proliferative vitreoretinopathy

· Background: Abnormal vitreoretinal relationships have recently been implicated in many vitreoretinal disorders. Sites of abnormal vitreoretinal adherences are likely to exist in eyes predisposed to rhegmatogenous retinal detachment (RD), causing either retinal tears or incomplete posterior vitreous detachment (PVD). The present study was designed in two parts to identify the risk for preoperative and postoperative proliferative vitreoretinopathy (PVR) due to incomplete PVD. · Methods: We prospectively evaluated the vitreoretinal relationships using high-resolution kinetic echography in 102 consecutive eyes of 100 patients with rhegmatogenous RD. In the first part, a case-control study was conducted to compare the vitreous status in patients with preoperative PVR (cases) with that in patients with non-PVR-complicated RD (controls). During the second part, patients with noncomplicated RD (65 eyes) who were operated on by a simple retinal attachment procedure were followed up for a mean period of 6.6 months to compare the recurrence of RD due to postoperative PVR according to their vitreous status. · Results: Patients with PVR on study entry had a higher prevalence of partial PVD (28 of 32 eyes, 87%) than did controls (25 of 70 eyes, 35%). The statistical significance of this difference was independent of all other variables studied. After a mean follow-up period of 6.6 months, the incidence of recurrence of RD associated with postoperative PVR was 33% in the eyes with incomplete PVD, compared with 4.9% in the eyes without incomplete PVD. · Conclusions: Our results support the notion that the occurrence of incomplete PVD in RD is a significant risk factor for preoperative and postoperative PVR. Received: 18 June 1997 Revised version received: 9 October 1997 Accepted: 15 October 1997     

Stereopsis after successful surgery for rhegmatogenous retinal detachment

Background

To evaluate stereopsis after successful surgery for unilateral rhegmatogenous retinal detachment (RD), and to investigate the relationship between stereopsis and clinical factors.

Methods

In 75 patients after RD surgery and 28 age-matched normal subjects, stereopsis was measured using the Titmus Stereo Test (TST) and TNO stereotest. Clinical data were collected, including age, gender, circumferential dimension of retinal tears, area and duration of RD, macular status, surgical procedures, postoperative spherical equivalent, and logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), low-contrast visual acuity, postoperative lens status (phakia/pseudophakia), and presence of postoperative epiretinal membrane (ERM), to determine the factors related to stereopsis.

Results

Stereopsis in patients after surgery was significantly worse than normal subjects (p?<?0.0001). Stereopsis in TST was significantly correlated with the area of RD (p?<?0.005), difference of postoperative spherical equivalent between two eyes (p?<?0.05), postoperative logMAR BCVA (p?<?0.005), difference of postoperative logMAR BCVA between two eyes (p?<?0.01), and low-contrast visual acuity (p?<?0.05). Stereopsis in TNO stereotest showed significant association with postoperative logMAR BCVA (p?<?0.05). Stereopsis in both stereotests were significantly worse in patients with macula-off RD than macula-on RD (p?<?0.005, p?<?0.01 respectively). No significant relationship was found between stereopsis and other factors. Multiple regression analysis revealed that macular status (on/off) had a significant correlation with both stereopsis in TST and TNO stereotest (p?=?0.028, p?=?0.019 respectively), whereas other clinical parameters were not relevant.

Conclusions

Stereopsis is significantly deteriorated in patients after RD surgery than in normal subjects. Stereopsis was associated with the difference in refraction between two eyes, postoperative visual acuity and contrast sensitivity, and preoperative macular status.     

Foveal detachment after successful retinal reattachment for macula on rhegmatogeneous retinal detachment: an ocular coherence tomography evaluation

PURPOSE: Foveal detachment after apparently successful retinal reattachment surgery for macula-on retinal detachments (RDs) has been previously documented. This pilot study aimed to utilize ocular coherence tomography (OCT) imaging to investigate foveal architecture after routine retinal detachment surgery and correlate this to visual acuity. METHODS: Prospective recruitment of patients attending one unit with macula-on RDs. Patients underwent full clinical examination including OCT preoperatively and RD surgery undertaken by scleral buckling, external drainage and air injection. Postoperatively patients had clinical examinations and OCT at 1 week, 1, 3, 6, and 12 months. RESULTS: A total of 12 consecutive patients were recruited into the study. All had macula-on RDs and normal OCTs at onset. There were no operative or postoperative complications. Retinal reattachment was achieved in all cases within 24 h postoperatively. At 1 month six of 12 patients (50%) showed foveal detachment on OCT, which was invisible on clinical examination. At 3 months, the foveal detachment persisted in four (33%) of these patients. In these cases the foveal detachment persisted at 6 months follow-up, however, a reduction in subfoveal fluid was noted. All cases had foveal reattachment by 12 months postoperatively. Visual acuity was closely correlated to the presence of foveal attachment. DISCUSSION: A high proportion of patients with successful retinal reattachment surgery had foveal detachments postoperatively. This phenomenon was associated with reduced visual acuity. The aetiology of this occurrence is unknown and warrants further investigation as there is the potential of a long-term effect on vision.     

Factors affecting visual recovery after successful repair of macula-off retinal detachments: findings from a large prospective UK cohort study

ObjectiveTo identify risk factors affecting visual outcomes in successfully re-attached macula-off rhegmatogenous retinal detachment (RD) surgery.DesignA prospective study, using online databases, of visual outcomes for 2074 macula-off retinal detachments that were successfully re-attached by vitrectomy and internal tamponade. The database included detailed retinal diagrams of each detachment.Main outcome measureThe probability of achieving a post-operative visual acuity (VA) of ≤0.30 LogMAR (Snellen 6/12 or better).ResultsMale patients accounted for 64.9% of the sample and the median age was 63 years old. The median pre-operative VA was counting fingers (LogMAR 1.98); this improved to 0.41 LogMAR post-operatively. A post-operative VA of ≤0.30 LogMAR was achieved for 1012 (48.8%) eyes and the factors affecting this were the patient age and gender, pre-operative VA, duration of central vision loss, PVR grade, lens status, total RD and the presence of any ocular co-pathology where the model area under the receiver operator curve was 71.6%.ConclusionsFrom the identified risk factors that decrease the probability of achieving a post-operative visual acuity of ≤0.30 LogMAR, the most important modifiable risk factor was the duration of central vision loss. Recent macula-off retinal detachments should be repaired within 72 h of the loss of central vision.Subject terms: Outcomes research, Retinal diseases     

可折叠球囊在视网膜脱离患者治疗中的应用

目的 观察可折叠球囊治疗视网膜脱离(RD)的临床效果。方法 回顾性分析2018年1月至2021年12月于中国人民解放军联勤保障部队第九八八医院接受可折叠顶压球囊(FCB)治疗的32例单纯孔源性RD(RRD)患者(FCB组)和接受可折叠人工玻璃体球囊(FCVB)治疗的68例严重眼外伤和硅油依赖眼伴RD患者(FCVB组)的临床资料,术后随访12个月,观察最佳矫正视力、眼压、视网膜复位情况及并发症发生情况。结果 FCB组和FCVB组患者术后最佳矫正视力均优于术前,差异均有统计学意义(均为P<0.05)。FCB组和FCVB组患者术前眼压分别为(14.26±2.05)mmHg(1 kPa=7.5 mmHg)、(28.34±3.17)mmHg,术后眼压分别为(15.19±3.02)mmHg和(10.82±3.79)mmHg,两组患者术前与术后眼压相比差异均有统计学意义(均为P<0.05)。术后两组患者视网膜均成功复位,均未见与FCB、FCVB相关的严重并发症发生。结论 可折叠球囊治疗RD安全、有效。     

Formation of proliferative vitreoretinopathy in primary rhegmatogenous retinal detachment

Proliferative vitreoretinopathy (PVR) is the only cause of ultimate failure following retinal detachment surgery. This study aimed to review the rate of postoperative PVR in a series of 186 consecutive patients with primary rhegmatogenous retinal detachments. All 186 detachments were repaired with a scleral buckling procedure combined with cryotherapy. Drainage of subretinal fluid was done at the discretion of the surgeon. The mean follow-up was 12 months. In this series 152 (82%) of primary detachments were repaired succesfully with a single operation. Sixty-eight percent of patients regained 0.3 or better visual acuity, and 3% of patients were left with visual acuity of 1/60 or less. After two or more operations the retina was attached in 96% of the cases. In 12 (6%) eyes PVR was responsible for the initial surgical failure. In 4 cases PVR (grade B and limited C) was present prior to surgery. In 3 cases PVR developed within 2 days postoperatively, in 3 cases after 3–6 weeks and in another 2 cases after 8–l0 months. Eight out of 12 (66%) PVR patients had undergone cataract surgery. One PVR case had preoperative intraocular inflammation. An association between the duration of retinal detachment, or drainage of subretinal fluid and the development of PVR could not be demonstrated. In conclusion, the rate of postoperative PVR in primary rhegmatogenous retinal detachments was low. PVR preoperatively present and pseudophakia may be risk factors.     

Proliferative vitreoretinopathy: relation to the extent of retinal detachment, size of retinal tears and coagulation surface

Preretinal dispersion of stimulated RPE cells has been suggested as a possible cause of the development of proliferative vitreoretinopathy (PVR). Retinal detachment (RD) and retinal breaks are associated with an exposure of corresponding areas of retinal pigment epithelium (RPE) which has been mechanically stimulated by coagulation. In a prospective, controlled study of 141 patients between 20 and 75 years of age, PVR grades were determined before and RD surgery and within six months following it PVR grades were correlated with the extent of RD, size of breaks, and area of coagulation. The severity of the PVR correlated significantly with both the extent of RD as well as the total number of coagulation exposures. There was a tendency toward higher grades of PVR with larger retinal breaks. The results are compatible with the hypothesis that at least certain variations of PVR are caused by preretinal dispersion of stimulated RPE cells.     

玻璃体切除联合空气填充治疗下方裂孔的孔源性视网膜脱离的短期疗效

目的 尝试应用玻璃体切除联合玻璃体腔空气填充治疗下方裂孔的孔源性视网膜脱离(RRD),观察其可行性.设计 回顾性病例系列.研究对象 2017年6月至2020年10月间在南京爱尔眼科医院接受23G经睫状体平坦部三通道行微创玻璃体切除术(PPV)联合玻璃体腔无菌空气填充治疗的下方裂孔的RRD患者45例(45眼).方法 所有...     

视网膜脱离后视网膜中央动脉血流动力学研究

目的：观察视网膜脱离后眼血循环的改变。方法：采用彩色多普勒成象技术对60例视网膜脱离患者的视网膜中央动脉进行测量。以对侧正常眼做对照，分别测量视网膜中央动脉的收缩期峰值流速（Vmax)、舒张末期流速（Vmin)、时间均值流速（Vtax)及搏动指数（PI）[PI=（Vmax-Vmin)/Vmean]。结果：患眼视网膜中央动脉的Vmax、PI较对照眼显著下降，并且患者年龄大于40岁或病程超过6个月者，下降明显。结论：视网膜脱离后视网膜中央动脉的血流速度下降，且与年龄及病程呈正相关。     

Cirugía combinada de trabeculostomía láser excímer y facoelmusificación: datos a un año en el mundo real de una MIGS de tipo láser

PurposeTo evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice.Patients and methodsSingle-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21 mmHg and an IOP reduction ≥ 20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively.ResultsThirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9 ± 2.6 mmHg (± standard deviation, SD) and decreased significantly at one year (16.3 ± 1.9; p < 0.0001). The mean number of IOP-lowering medications decreased from 1.7 ± 0.7 to 0.3 ± 0.8 (p < 0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months.ConclusionCombining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting.     

High-density silicone oil as an intraocular tamponade in complex retinal detachments

Objective: To evaluate the efficacy and safety of high-density silicone oil (HDSO) as an internal retinal tamponade after vitrectomy for complicated retinal detachment.Design: Retrospective, non-randomized study.Participants: Forty-one eyes of 41 patients who were 5–73 years of age.Methods: Medical records of patients with retinal detachment (RD) complicated with inferior proliferative vitreoretinopathy (PVR) requiring internal tamponade with HDSO were reviewed. Eyes with retinal vascular diseases and inflammatory diseases were excluded from the study. Follow-up examinations were scheduled at 1 week and 1, 3, 6, and 12 months after the initial surgery.Results: Median value of follow-up was 8 months (range, 3–40 months). Twenty-five patients had rhegmatogenous RD with significant PVR and the remaining patients had complicated RD secondary to trauma. Preoperative visual acuity was 2.55 ± 0.75 logMAR, which became 1.89 ±0.91 at the last follow-up visit (p < 0.05). Complications included increased intraocular pressure (9.7%), hypotony (2.4%), cataract (57.1%), silicone oil in anterior chamber (17%), persistent total corneal edema (7.3%), band keratopathy (7.3%), and significant inflammation (2.4%). Intraretinal or subretinal fibrosis was found in 12 eyes (29.2%). HDSO removal was performed after a mean period of 5.7 months (range, 3–34 months) in 34 patients. The anatomical success was 87.8%.Conclusions: The high anatomical success rate of 87.8% is a satisfactory result for these complicated RD cases. Subretinal proliferations and early emulsification limit the results. Further studies, with longer follow-ups and more patients, are needed to be conclusive.     

Tailored vitrectomy and laser photocoagulation without scleral buckling for all primary rhegmatogenous retinal detachments

AIM: To investigate the anatomical and functional results and the complications in eyes operated on using vitrectomy without scleral buckling for all forms of rhegmatogenous retinal detachment (RRD). METHODS: All cases of primary RRD at the University Hospital of Lund, Lund, Sweden, treated by one surgeon during a period of 3 years were retrospectively reviewed. In 131 (98%) of 134 consecutive cases, a final follow-up record of 3-14 months was obtained, and these eyes were included in the study. The surgical protocol was tailored for each case and consisted of vitrectomy, laser photocoagulation and tamponade. Preoperative and intraoperative variables were analyses for risk for redetachment and postoperative proliferative vitreoretinopathy (PVR). RESULTS: Complete reattachment was achieved in 87% of cases (114/131) after one operation and in 95% cases after > or =1 operation. A primary detachment of >1 quadrant was the only significant risk factor for redetachment (p<0.05). The most common cause of redetachment was progressive PVR. Significant risk and factors for PVR postoperatively were a poor preoperative visual acuity and a high number of laser effects during surgery (p<0.05). The visual acuity for the total number of eyes, macula-off eyes, and pseudophakic as well as phakic eyes, improved significantly. The visual acuity for macula-on eyes did not change significantly. Six patients developed ocular hypertension and another 6 an epiretinal membrane. Three patients reported a visual field defect. Increased lens opacification was seen in 64 of the 94 (68%) phakic eyes. CONCLUSIONS: The tailored vitrectomy protocol is well suited to all types of RRD. Increased lens opacification in phakic eyes is common, but visual acuity is considerably improved in phakic as well as pseudophakic eyes. PVR development postoperatively is related to the extent of laser treatment, indicating that the protocol may be even further optimised in the future.     

学龄期儿童独眼视网膜脱离临床特点和手术效果分析

目的：探讨学龄期儿童独眼视网膜脱离(RD)潜在病因以及RD临床特点。

方法：回顾性分析2015-11/2021-05于本院就诊的7～14岁儿童患者如下病例：患眼RD且对侧眼盲目(独眼RD)。描述并探讨其一般情况及RD病因、临床类型、手术方式、眼内填充物类型、手术前后视功能和解剖预后等。

结果：共纳入27例27眼独眼RD患者,随访至少6mo以上。平均就诊年龄为10.63±2.30岁。家族性渗出性玻璃体视网膜病变(FEVR)(11/27,41%),先天性青光眼术后(6/27,22%)和Stickler综合征(3/27,11%)为主要致病原因。其中,孔源性视网膜脱离(RRD)占78%(21/27),孔源性视网膜脱离患者(17/21)中81%的患者表现为增殖性玻璃体视网膜病变(PVR)C3及以上。共有85%(23/27)的患者行玻璃体切除术,其中83%(19/23)的患者手术中联合硅油填充。末次随访最佳矫正视力(BCVA,LogMAR)低于1.7的患者占78%(21/27),82%(22/27)的患者末次随访时视网膜平复在位,而41%(11/27)的患者末次随访时硅油尚未取出。

结论：学龄期儿童独眼RD常合并潜在的先天或遗传性眼病,且常表现为严重的RD和较重的PVR反应,多需玻璃体切除术联合硅油注入,视功能和解剖预后也较差。     

玻璃体视网膜手术治疗外伤性视网膜脱离合并增生性玻璃体视网膜病变的临床观察

目的：探讨玻璃体视网膜手术（ VRS）治疗合并增生性玻璃体视网膜病变（ PVR）的外伤性视网膜脱离（RD）患者的临床疗效。方法对2007年6月至2013年3月50例（51只眼）合并PVR的外伤性RD患者行VRS治疗,术后随访5～26个月,平均10．8个月。结果视网膜完全解剖复位47只眼,部分复位3只眼,未复位1只眼,总有效率98．4％。视力提高者41只眼（80．39％）;视力不变者7只眼（13．73％）,视力下降者4只眼（7.84％）。51只眼均行硅油填充术,继发性青光眼14只眼（27．45％）;8只眼因术后硅油进入前房行前房冲洗术（15．69％）;5只眼视网膜复位后Ⅱ期硅油取出术后低眼压或多次复发RD,长期硅油高粘度填充（9．80％）。结论通过VRS手术能有效解除外伤性PVR引起的视网膜牵拉,复位视网膜,提高视力。