Сравнительный анализ отдаленных результатов хирургического лечения первичной регматогенной отслойки сетчатки с использованием экстра- и интраокулярных подходов

Abstract

Purpose . Analysis of clinical efficacy of surgical treatment of primary rhegmatogenous retinal detachment (PRRD) using extra- and intra-scleral approaches, depending on the stage of proliferative vitreoretinopathy (PVR). Material and methods . The analysis of long-term results in surgical treatment of 116 eyes (112 patients) with PRRD was carried out. Duration of retinal detachment ranged from 7 days to 5 months (average 4.5 weeks). The structure of PVR stages: A – 31 eyes, B – 31 eye, C – 54 eyes. Macular detachment occurred in 47 eyes. Visual acuity preoperatively varied from 0.005 to 1.0 (average 0.25). Extra-scleral approaches were used in 49 eyes of 45 patients. Endovitreal 20G surgery was performed in 67 eyes of 67 patients. Evaluation of the clinical efficacy of treatment in all eyes was carried out in the follow-up period of 3-7 postoperative days and 3-4 years later. Results and discussion . After the extraocular surgery the retinal anatomic reattachment was achieved at 2-3 day of postoperative period in 45 eyes (91.8%). Partial retinal reattachment was revealed in 4 eyes. After reoperation a complete retinal reattachment was achieved in all eyes. After endovitreal surgery it was noted at 2-3 day that the retina attached in 64 eyes (95.5%), in 3 eyes the retinal attachment was failed (4.5%), where a repeated silicone tamponade was performed. Relapses of PRRD occurred in 11 eyes (12.2%), in their structure: 6 eyes after extra-scleral approach – in the period from 2.5 to 12 months; 5 eyes (7.4%) after the intraocular approach – in the period from 4 to 18.5 months. After a repeated endovitreal surgery the anatomic reattachment of retina was achieved in all cases. Conclusions . The main reason of PRRD relapses was the progression of vitreo-proliferative process. Intraocular surgery with the use of plugging fluids (silicone, gas, air) allows more reliably reduce the risk of postoperative complications, occurrence of PRRD relapses. Episcleral approaches in PRRD treatment continue to be the method of choice in the initial PVR stages.