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ENGLISH ABSTRACT
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
杨琼
魏文斌
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20220330-00122
Efficacy of scleral buckling for retinal detachment secondary to familial exudative vitreoretinopathy
Yang Qiong
Wei Wenbin
Authors Info & Affiliations
Yang Qiong
Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Wei Wenbin
Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
·
DOI： 10.3760/cma.j.cn115989-20220330-00122
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摘要

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。

家族性渗出性玻璃体视网膜病变;视网膜脱离;巩膜扣带术;疗效;视网膜复位率;视力
ABSTRACT

ObjectiveTo evaluate the efficacy of scleral buckling in the treatment of retinal detachment (RD) secondary to familial exudative vitreoretinopathy (FEVR).

MethodsAn 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.

ResultsThe 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.

ConclusionsOn 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.

Familial exudative vitreoretinopathy;Retinal detachment;Scleral buckling;Treatment outcomes;Retinal reattachment rate;Visual acuity
Wei Wenbin, Email: mocdef.3ab61nibnewiew_rt
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引用本文

杨琼,魏文斌. 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[J]. 中华实验眼科杂志,2023,41(09)：886-890.

DOI:10.3760/cma.j.cn115989-20220330-00122

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家族性渗出性玻璃体视网膜病变(familial exudative vitreoretinopathy，FEVR)是一种少见的视网膜血管发育异常，多为常染色体显性遗传，也可为常染色体隐性遗传或X连锁遗传，部分患者无家族史[ 1 ]。该病主要表现为视网膜周边血管分化异常及不完全血管化，进而引起视网膜一系列病理改变，包括视网膜新生血管化、渗出、出血，严重者可致视网膜脱离(retinal detachment，RD)[ 2 ]。目前对于FEVR继发性RD的手术治疗主要包括巩膜扣带术及玻璃体切割术。2种术式适应症有所不同，简单的孔源性RD适合巩膜扣带术，而牵拉性RD和复杂的RD则更适合玻璃体切割手术[ 3 , 4 ]。目前文献报道的FEVR继发性RD的最终视网膜复位率为35.29%~100%[ 5 , 6 , 7 , 8 ]，产生差异的主要原因在于研究的样本量不同、研究对象的病程及严重程度不同以及不同研究者对于手术认知不同。FEVR继发性RD常双眼发病，病变起始部位多为周边视网膜，患病人群多为儿童或中青年，常不合并玻璃体后脱离等。巩膜扣带术是FEVR继发的简单孔源性RD的合适术式。对于FEVR继发的复杂RD，考虑到发病人群、年龄、病情本身特点以及玻璃体手术可能的并发症，本研究仍将巩膜扣带术作为首选术式，并对巩膜扣带术治疗FEVR继发性RD的疗效和安全性进行评估，为FEVR继发性RD的临床治疗术式选择提供参考依据。
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备注信息
A
魏文斌，Email：mocdef.3ab61nibnewiew_rt
B

杨琼：试验设计、实施研究、总结分析数据、文章撰写；魏文斌：试验设计、对研究内容作批评性审阅

C
所有作者均声明不存在利益冲突
D
北京市自然科学基金重点研究专题项目 (Z220012)
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