玻璃体皮质残余对原发性流变性视网膜脱离眼正常视网膜解剖结构的影响。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2024-10-01 DOI:10.1016/j.oret.2024.04.015

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引用次数: 0

摘要

目的探讨玻璃体皮质残留物（VCR）切除对流变性视网膜脱离（RRD）患者正常视网膜解剖结构的影响。主要结果测量主要结果：术后1个月视网膜移位率和视网膜外皱褶（ORF）。次要结果：外缘膜（ELM）和椭圆带（EZ）的连续性，以及术后6个月时最小分辨角（logMAR）最佳矫正视力（BCVA）的对数。术中，42 只眼睛（40.8%）发现了周边 VCR（pVCR），37 只眼睛成功剥离了≥2 个象限的 VCR。在 37 只眼睛（35.9%）中发现了黄斑 VCR（mVCR），并在 29 只眼睛中成功剥离。手术结束时，44.7% 和 55.3% 的眼睛分别用 20% 的六氟化硫气体和 1000 厘沲的硅油进行了填塞。唯一与移位明显相关的变量是气体填塞与硅油填塞（P = 0.001），而视网膜移位与 pVCRs（P = 0.58）或 pVCRs 被剥离的象限数（P = 0.39）之间无明显关联。术后 1 个月，有 24 只眼睛（23.3%）在全球范围内检测到 ORF。回归分析表明，ORFs 与术中检测到的 mVCRs 直接相关（P = 0.02），ORFs 与 mVCRs 剥离间接相关（P = 0.004）。在6个月的随访（FU）中，黄斑VCRs剥离并不影响ELM和EZ的连续性。结论 pVCRs 的剥离似乎不会影响视网膜移位率，而 mVCRs 的剥离与 ORFs 发生风险的降低有关，但不会对 6 个月随访时 ELM/EZ 的连续性产生不利影响。术中未检测到mVCRs或在手术中进行了mVCRs剥离的患者在6个月FU时的视力明显更好。

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Influence of Vitreous Cortex Remnants on Normal Retinal Anatomy in Eyes with Primary Rhegmatogenous Retinal Detachment

Purpose

To investigate the influence of vitreous cortex remnants (VCRs) removal on normal retinal anatomy in eyes with rhegmatogenous retinal detachment (RRD).

Design

Prospective cohort study.

Subjects

Patients with primary RRD operated with pars plana vitrectomy (PPV).

Methods

Blue fundus autofluorescence and spectral-domain OCT were obtained preoperatively, and at 1 and 6 months after operation.

Main Outcome Measures

Primary outcomes: rate of retinal displacement and outer retinal folds (ORFs) at 1 month after operation. Secondary outcomes: continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ), and the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at 6 months after operation.

Results

One hundred three eyes were included. Intraoperatively, peripheral VCRs (pVCRs) were found in 42 eyes (40.8%) and successfully peeled off from ≥2 quadrants in 37 eyes. Macular VCRs (mVCRs) were detected in 37 (35.9%) and successfully peeled off in 29 eyes. At the end of operation 44.7% and 55.3% of the eyes were tamponaded with 20% sulfur hexafluoride gas and silicone oil 1000 centistokes, respectively. The only variable significantly associated with displacement was the use of gas tamponade versus silicone oil (P = 0.001), whereas no significant association was found between retinal displacement and pVCRs (P = 0.58) or number of quadrants from which pVCRs were peeled off (P = 0.39). At 1 month postoperatively, ORFs were globally detected in 24 eyes (23.3%). Regression analysis showed a direct correlation between ORFs and the intraoperative detection of mVCRs (P = 0.02) and an indirect correlation between ORFs and mVCRs peeling (P = 0.004). Macular VCRs peeling did not influence the continuity of ELM and EZ at the 6-month follow-up (FU). Intraoperative absence of mVCRs (P = 0.0016) and peeling of mVCRs (P = 0.003) were associated with logMAR BCVA ≤0.3 at the 6-month FU.

Conclusions

Peeling of pVCRs did not seem to influence the rate of retinal displacement, whereas peeling of mVCRs was associated with a reduced risk of developing ORFs without detrimental effect on the continuity of ELM/EZ at 6-month FU. The patients without mVCRs detected intraoperatively, or who underwent mVCRs peeling during operation, showed a significantly better visual acuity at the 6-month FU.