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LONG-TERM OUTCOMES FOR OPTIC DISK PIT MACULOPATHY AFTER VITRECTOMY

机译：视神经支配术后视盘肉芽肿病的长期结果

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Purpose:To evaluate the efficacy of pars plana vitrectomy for congenital optic disk pit maculopathy with various adjuvant techniques, including gas tamponade, internal limiting membrane peel, and temporal optic disk endolaser in a multicenter study with long-term follow-up.Methods:A retrospective chart review was performed to identify eyes that underwent surgical repair for congenital optic disk pits and serous macular detachment with or without macular retinoschisis from four retinal centers across Canada from 2003 to 2013. Data collected included surgeries performed, preoperative and postoperative vision, central retinal thickness, and presence or absence of subretinal fluid. Optical coherence tomography was used to define anatomical success (i.e., foveal reattachment).Results:Thirty-two eyes of 32 patients with optic disk pits and serous macular detachments were identified that had undergone surgical repair. All eyes underwent pars plana vitrectomy and induction of posterior vitreous detachment if one was not present. Additional procedures performed on occasion included internal limiting membrane peel (n = 8), temporal optic disk pits endolaser (n = 7), and gas tamponade (air, C3F8 or SF6; n = 31). After vitrectomy surgery, foveal attachment was achieved in 26 of 32 eyes (81.3%). The average number of surgeries required was 1.4 0.6, with a maximum of 3 vitrectomies (n = 2). Mean change in best-corrected visual acuity was -0.47 +/- 0.54 logMAR units, which corresponds to approximately 5 lines of visual improvement (P < 0.001). Median time to reattachment was 416 days. Preoperative vision, preoperative symptom days, and age were not associated with postoperative reattachment. Similarly, internal limiting membrane peel and temporal endolaser were not associated with postoperative reattachment, nor was there a difference between air and SF6 and C3F8 gas tamponade. Elevated preoperative central retinal thickness was associated with a lower chance of postoperative reattachment (P = 0.007) and was also the best prognostic indicator of success (P = 0.039).Conclusion:Vitrectomy for macular detachment due to optic disk pit has good long-term success and results in an improvement in visual acuity. However, adjuvant techniques such as internal limiting membrane peel and temporal endolaser may not improve outcomes, nor does there seem to be a difference between short- and long-acting gases. Patients should be made aware that it can take more than a year and multiple surgeries to achieve foveal reattachment and that increased baseline central retinal thickness is a poor prognostic sign.
机译：目的：在长期随访的多中心研究中，采用包括气体填塞，内部限制膜剥离和颞视性内镜激光在内的多种辅助技术，评估平板状玻璃体玻璃体切除术对先天性视盘坑黄斑病变的疗效。进行回顾性图表审查，以鉴定2003年至2013年来自加拿大四个视网膜中心的先天性视盘凹坑和浆膜性黄斑脱离伴或不伴黄斑视网膜劈裂的手术修复。收集的数据包括进行的手术，术前和术后视力，中央视网膜厚度以及是否存在视网膜下液。结果采用光学相干断层扫描来定义解剖学上的成功（即中央凹再植）。结果：确定32例患有视盘凹陷和浆液性黄斑脱离的患者的32眼进行了手术修复。如果一只眼睛不存在，则对所有眼睛进行平面玻璃体切除术并诱导玻璃体后脱离。偶尔执行的其他程序包括内部限制膜剥离（n = 8），颞视盘凹坑内激光（n = 7）和填塞气塞（空气，C3F8或SF6; n = 31）。玻璃体切除术手术后，在32只眼中有26只（81.3％）实现了中央凹附着。平均所需的手术数量为1.4±0.6，最多3个玻璃体切除术（n = 2）。最佳矫正视力的平均变化为-0.47 +/- 0.54 logMAR单位，大约相当于5条视力改善线（P <0.001）。重新安置的中位数时间为416天。术前视力，术前症状天数和年龄与术后再植无关。同样，内部限制膜剥落和颞内激光与术后再连接无关，空气与SF6和C3F8气填塞之间也没有差异。术前视网膜中央厚度的增加与术后再连接的机会较低（P = 0.007）有关，也是成功的最佳预后指标（P = 0.039）。结论：玻璃体切除术治疗因视盘凹陷而引起的黄斑脱离具有良好的长期效果成功并导致视敏度的提高。但是，辅助技术（例如内部限制膜剥离和颞内激光）可能无法改善预后，短效和长效气体之间似乎也没有区别。应该使患者意识到，需要多于一年的时间和多次手术才能达到中央凹再附着，基线中央视网膜厚度的增加是不良的预后征兆。

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