OCT-, anatomische und funktionelle Ergebnisse nach Plombenchirurgie bei Macula-off rhegmatogener Ablatio retinae

Zusammenfassung

Hintergrund: Es war Ziel dieser retrospektiven Studie über die anatomischen, funktionellen und optikkohärenztomografischen (OCT-) Ergebnisse nach Plombenchirurgie bei Macula-off rhegmatogener Ablatio retinae zu berichten.

Material und Methoden: 87 Patienten (87 Augen), die wegen einer rhegmatogenen Macula-off Ablatio mit Plombenchirurgie versorgt worden waren und postoperativ eine Nachbeobachtungszeit ≥ 6 Monate aufwiesen, wurden in die Studie aufgenommen. Patienten mit Riesenriss, Oradialyse, chorioretinaler Dystrophie, proliferativer Vitreoretinopathie (PVR) ≥ C1, Schisisamotio und Glaskörpertrübung wurden ausgeschlossen. Die Netzhautwiederanlage und die prä- und postoperative Sehleistung wurden untersucht. Zur Analyse der Photorezeptor-Innen/Außensegmente (IS/OS) und der External-Limiting-Membrane-(ELM-)Integrität wurde eine Spektral-Domain-OCT-Untersuchung durchgeführt. Die potenziellen Risikofaktoren, welche die postoperative Sehleistung beeinflussen, wurden mit linearer multivariater Regression analysiert.

Ergebnisse: Eine primäre Netzhautanlage wurde bei 81 Augen (93,8 %) erreicht. Die finale Erfolgsrate nach Pars-plana-Vitrektomie mit Silikonöltamponade lag bei 98,7 % (86 Augen). Erhaltene ELM- (OR 0,58; p = 0,004) und IS/OS-Integrität (OR 0,84; p = 0,031) und eine Ablassung subretinaler Flüssigkeit (OR 0,42, p < 0.0001) wurden als signifikant unabhängige Faktoren ermittelt, welche die postoperative Sehleistung günstig beeinflussen. Dauer der Netzhautablösung > 6 Tage (OR 1,46; p = 0,04), 2–3 Netzhautforamina (OR 1,30; OR 1,36; p < 0,0001) waren signifikant unabhängige Faktoren, die den postoperativen Visus ungünstig beeinflussen. Deutliche IS/OS-Diskontinuität war der wichtigste Faktor für den postoperativ ungünstigen Visus (β 0,724; OR 2,06; p < 0,0001).

Schlussfolgerung: Deutliche IS/OS-Diskontinuität nach erfolgreicher Chirurgie bei Macula-off rhegmatogener Ablatio retinae scheint ein wichtiger Prädiktor für die postoperative Sehleistung zu sein.

Abstract

Purpose: The aim of this study was to evaluate results of optical coherence tomography (OCT) with regard to anatomic and functional outcome after scleral buckling surgery (SBS) in macula-off rhegmatogenous retinal detachment (RRD).

Methods: Medical charts of 87 patients (87 eyes), who underwent SBS for macula off RRD were analysed retrospectively. Patients with follow-up ≥ 6 months were included. Exclusion criteria were giant retinal tears, retinal dialysis, chorioretinal dystrophies, proliferative vitreoretinopathy ≥ grade-C1, schisis detachment and vitreous opacities. Reattachment success rate, pre- and postoperative visual acuity (VA) were examined. Postoperative spectral-domain (SD) OCT images were evaluated. The status of photoreceptor inner segment/outer segment (IS/OS) and external limiting memrane (ELM) junction were analysed. Potential risk factors influencing postoperative VA were evaluated by using linear multivariate logistic regression.

Results: The primary anatomic success rate was 93.8 % (81 eyes), final success rate was 98.7 % (86 eyes). Preserved ELM (OR 0.58, p = 0.004) and IS/OS integrity (OR 0.84, p = 0.031), drainage of subretinal fluid (OR 0.42, p < 0.0001) were detected as significant independent factors for influencing postoperative VA favourably. Duration of detachment > 6 days (OR 1.46, p = 0.04), two/three retinal breaks (OR 1.30, OR 1.36, p < 0.0001) were significant independent risk factors for a poor postoperative VA. Severe IS/OS disruption was the most important risk factor for poor postoperative VA (β 0.724, OR 2.06, p < 0.0001).

Conclusion: Severe IS/OS disruption may be the most important predictor of postoperative VA after successful surgery in macula-off rhegmatogenous retinal detachment.

Schlüsselwörter

rhegmatogene Netzhautablösung - Plombenchirurgie - Spektral-Domain-optische Kohärenztomografie

Key words

rhegmatogenous retinal detachment - scleral buckling surgery - spectral domain optical coherence tomography

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