巩膜扣带术治疗家族性渗出性玻璃体视网膜病变继发视网膜脱离效果分析

Efficacy of scleral buckling for retinal detachment secondary to familial exudative vitreoretinopathy

目的分析巩膜扣带术治疗家族性渗出性玻璃体视网膜病变(FEVR)继发视网膜脱离(RD)的效果。方法采用系列病例观察研究,纳入2010年7月至2021年3月于北京同仁医院采用巩膜扣带术治疗的FEVR继发RD患者共37例42眼,其中男30例35眼,女7例7眼;平均年龄(15.21±5.42)岁。全身麻醉下行巩膜扣带术,孔源性RD患者22眼,术中封闭裂孔,其中21眼采用局部外加压联合环扎,1眼采用放射脊加压;牵拉性RD患者13眼,术中解除牵拉,其中12眼采用局部外加压联合环扎并放视网膜下液,1眼采用巩膜扣带术联合玻璃体手术;牵拉合并孔源性RD患者7眼,术中在封闭裂孔的基础上同时解除牵拉,其中4眼采用局部外加压联合环扎并放视网膜下液,3眼采用巩膜扣带术联合玻璃体切割手术。平均随访时间(30.61±10.50)个月。主要观察指标包括术眼最佳矫正视力(BCVA)、视网膜复位情况及并发症发生情况。结果术后末次随访时平均LogMAR BCVA为0.83±0.50,优于术前的1.10±0.39,差异有统计学意义(t=6.639,P<0.001)。一次性视网膜复位39眼,未复位3眼,其中孔源性RD复位率95.45%(21/22),牵拉性RD复位率84.62%(11/13),牵拉合并孔源性RD复位率100%(7/7)。所有患者术后随访期间均未出现严重并发症。结论根据FEVR继发RD的病情选择合适的手术策略,可有效提高巩膜扣带术的治疗成功率。

Objective To evaluate the efficacy of scleral buckling in the treatment of retinal detachment(RD)secondary to familial exudative vitreoretinopathy(FEVR).Methods An observational case series study was conducted.A total of 37 patients(42 eyes)of RD secondary to FEVR who were treated with scleral buckling in Beijing Tongren Hospital from July 2010 to March 2021 were enrolled.There were 30 males(35 eyes)and 7 females(7 eyes),with an average age of(15.21±5.42)years old.Scleral buckling under general anesthesia was performed in all patients.There were 22 eyes with rhegmatogenous RD(RRD),of which 21 eyes were treated with local external compression combined with cerclage,and 1 eye was treated with radial spinal compression.There were 13 eyes with tractive RD(TRD),of which 12 eyes were treated with local external compression combined with cerclage and subretinal fluid drainage,and 1 eye was treated with scleral buckling combined with vitrectomy.There were 7 eyes with RRD combined with TRD,of which 4 eyes were treated with local external compression combined with cerclage and subretinal fluid drainage,and 3 eyes were treated with scleral buckling combined with vitrectomy.The average follow-up time was(30.61±10.50)months.The main outcomes were best corrected visual acuity(BCVA)of the operated eye converted to the logarithm of the minimum angle of resolution,retinal reattachment rate,and incidence of complications.The study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TRECKY2018-056-GZ[2022]-07).Written informed consent was obtained from each subject or their guardians before entering the cohort.Results The average BCVA was 0.83±0.50 at last follow-up after surgery which was better than 1.10±0.39 before surgery,and the difference was statistically significant(t=6.639,P<0.001).There were 39 eyes with retinal reattachment and 3 eyes without retinal reattachment.The reattachment rate was 95.45%(21/22)in RRD,84.62%(11/13)in TRD,and 100%(7/7)in RRD combined with TRD.No serious complication occurred in any patients during postoperative follow-up.Conclusions On the premise of optimized surgical strategy based on the indications of RD secondary to FEVR,scleral buckling has a high retinal reattachment rate in the treatment of RD secondary to FEVR.