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網膜剝離

著者: 平田 憲 林眼科病院

監修: 沖波聡 倉敷中央病院眼科

著者校正/監修レビュー済:2021/09/01
患者向け説明資料
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
平田 憲 : 特に申告事項無し[2021年]
監修:沖波聡 : 特に申告事項無し[2021年]

改訂のポイント
  1. 定期レビューを行った(変更なし)。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 網膜剝離とは、眼の発生時期における眼杯の内板(後の感覚網膜)と外板(後の網膜色素上皮)の間で起こる分離である。元来、これら2層の間には機械的な接着機構が存在せず、網膜色素上皮のポンプ作用、網膜色素上皮の微絨毛様構造による視細胞の保持により、網膜の接着状態が維持されている。
  1. 種々の原因(網膜裂孔形成による硝子体側の液流入、炎症による脈絡膜血管透過性亢進、腫瘍血管からの漏出による網膜-色素上皮間の液貯留、低蛋白血症による膠質浸透圧の低下による液貯留、硝子体による網膜の牽引)により、網膜剝離は生じる。
  1. ただし、一般的に網膜剝離といえば、網膜裂孔形成に起因する網膜剝離を指すことが多く、他の網膜剝離(牽引性網膜剝離、滲出性網膜剝離)についても鑑別すべき疾患として理解しておく必要がある。
 
  1. 網膜剝離の発症頻度および危険因子(推奨度2O)(参考文献:[1][2][3][4][5][6][7][8]
  1. 発症頻度は文献により異なるものの10万人あたり3.9~12人で、日本人の発症頻度は10万人あたり10.4人である。危険因子として、男性、遺伝性硝子体網膜症、近視、網膜格子状変性、retinal tuft、変性性網膜分離、網膜裂孔・円孔、無・偽水晶体眼、YAGレーザー後嚢切開、その他の硝子体を操作する手術、外傷の既往、サイトメガロウイルス網膜炎の既往、急性網膜壊死の既往、片眼の網膜剝離の既往、がある。
問診、診察のポイント  
  1. 視力低下や視野異常の有無をまず確認する。網膜剝離が進行すれば、周辺側から中心部に向かって進行する視野異常を自覚する。しかし、進行が遅い網膜剝離の場合、視野異常を自覚しないこともある。
    視力低下は、網膜剝離が黄斑部に進行するか、裂孔形成時に硝子体出血が生じることで自覚される。しかし、視野異常と同様、進行がゆっくりの場合、健眼で日常生活を送っているため、自覚症状に乏しい。
  1. 飛蚊症、光視症の自覚の確認は、網膜剝離の前駆症状として重要である。飛蚊症は、後部硝子体剝離によって増悪するため、以前から飛蚊症がある場合でも、急な飛蚊症の増加を訴えることが多い。

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文献 

著者: R Törnquist, S Stenkula, P Törnquist
雑誌名: Acta Ophthalmol (Copenh). 1987 Apr;65(2):213-22.
Abstract/Text A population-based series of retinal detachments (RD) collected during a 10-year period (538 patients, 590 'cases', i.e. diseased eyes including new RD after 6 months in the same eye) is reported. The annual incidence was 10.6 per 100,000 population. Bilaterality was observed in 11.2%. In this material preponderance of the right eye was found. In non-traumatic RD there was a small sex difference, with a higher incidence among females. Older persons were at high risk of sustaining RD, as were myopes. In myopic males the risk increased with the degree of myopia and with increasing age. In myopic females the greatest risk was found in the age group 30-59 years. Myopic eyes are probably also more vulnerable to traumatic RD. Lattice degeneration was more common in middle-aged than in older patients and was also more common in myopic eyes than in eyes with other phakic RD. High myopia (greater than -5D) was more frequent in patients with lattice degeneration than in those without. Aphakia was found to be an important predisposing factor for RD. A classification taking into account the above-mentioned factors is proposed.

PMID 3604613  Acta Ophthalmol (Copenh). 1987 Apr;65(2):213-22.
著者: S R Wilkes, C M Beard, L T Kurland, D M Robertson, W M O'Fallon
雑誌名: Am J Ophthalmol. 1982 Nov;94(5):670-3.
Abstract/Text We studied the incidence of rhegmatogenous retinal detachment in Rochester, Minnesota, for the nine-year period from 1970 through 1978. The age-adjusted rate for idiopathic rhegmatogenous retinal detachment was 10.1 per 100,000 population per year (45 cases). Including 12 cases of aphakic retinal detachments, the age-adjusted incidence was 12.9 per 100,000 population per year. Not surprisingly, the incidence rate increased with age in both sexes. By extrapolation from the Rochester rates, the number of cases per year of idiopathic retinal detachment in the United States would be expected to be about 22,000, and the number of both aphakic and idiopathic phakic cases per year would be expected to approach 28,000.

PMID 7148948  Am J Ophthalmol. 1982 Nov;94(5):670-3.
著者: M H Haimann, T C Burton, C K Brown
雑誌名: Arch Ophthalmol. 1982 Feb;100(2):289-92.
Abstract/Text A survey of rhegmatogenous retinal detachment during 1976 was conducted on the population of Iowa. The annual incidences (per 100,000 populations) of four types of detachment were determined: nontraumatic phakic (6.1), traumatic phakic (1.0), nontraumatic aphakic (4.9), and traumatic aphakic (0.4). The incidences of nontraumatic phakic detachment for men and women were similar, although there was a preponderance of women that reflected their greater representation in the general population. The proportions of men were significantly higher in traumatic detachments compared with nontraumatic detachments. Men tended to be younger than women for all types of detachment; however, only in nontraumatic aphakic detachment was there a significant difference between mean ages. There was an insignificant preponderance of right eye involvement in all four detachment groups.

PMID 7065947  Arch Ophthalmol. 1982 Feb;100(2):289-92.
著者: T Y Wong, J M Tielsch, O D Schein
雑誌名: Arch Ophthalmol. 1999 Mar;117(3):379-83.
Abstract/Text OBJECTIVE: To determine the incidence of retinal detachment (RD) operations in a multiracial Southeast Asian population.
DESIGN: Population-based incidence study using a universal medical savings database in Singapore.
METHODS: Information on all RD operations performed for rhegmatogenous RD (International Classification of Diseases, Ninth Revision, Clinical Modification code 361.0) between 1993 and 1996 was retrieved and analyzed from a population-wide, government-administered medical savings database. Exudative, tractional, and unoperated-on rhegmatogenous RD are excluded. The 1990 Singapore population census was used to allow an estimation of age-, sex-, and race-specific annual incidence of RD.
RESULTS: Between 1993 and 1996, 1126 RD operations were performed on Singapore residents. The average annual incidence of RD operations was 10.5 per 100,000 population (95% confidence interval [CI], 10.2-10.9). The annual incidence was highest for Chinese (age-adjusted incidence, 11.6 per 100,000), followed by Malays (7.0 per 100,000), and lowest for Indians (3.9 per 100,000). The age-adjusted relative risk of RD operation for Chinese compared with Indians was 3.0 (95% CI, 2.9-3.1). Males were twice as likely as females to require RD surgery (age-adjusted relative risk, 2.0; 95% CI, 1.7-2.4). Chinese men 40 years and older had a 30.9 times higher risk (95% CI, 9.9-96.1) than Indian females younger than 40 years.
CONCLUSION: The incidence of RD is strongly associated with male sex and ethnic origin.

PMID 10088817  Arch Ophthalmol. 1999 Mar;117(3):379-83.
著者: K Sasaki, H Ideta, J Yonemoto, S Tanaka, A Hirose, C Oka
雑誌名: Graefes Arch Clin Exp Ophthalmol. 1995 Dec;233(12):772-6.
Abstract/Text BACKGROUND: The epidemiology of rhegmatogenous retinal detachment in Asians is not well known. We studied the epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan.
METHODS: The study was based on a retrospective chart review of hospital patients who were treated for primary rhegmatogenous retinal detachment in 1990. The data were collected from seven hospitals in the Kumamoto area.
RESULTS: From a population of 1 840 000, 192 residents developed retinal detachment. The annual incidence was therefore 10.4 per 100 000 population (9.6 for males, 11.2 for females). The incidences of three types of detachment-nontraumatic phakic, aphakic, and blunt trauma--were 9.8, 0.5 and 0.2 per 100 000 population, respectively. In 109 of 180 patients (60.6%) with nontraumatic phakic detachment, retinal breaks were associated with lattice degeneration. In females, 14 of 106 nontraumatic phakic cases (13.2%) were secondary to macular holes.
CONCLUSION: Compared with previously published studies from other countries, the incidence of detachments associated with lattice degeneration and macular hole was higher, while the incidences of aphakic detachment and detachment due to blunt trauma were lower in Japan. Racial factors and living habits may affect the development of retinal detachment.

PMID 8626085  Graefes Arch Clin Exp Ophthalmol. 1995 Dec;233(12):772-・・・
著者: Philip J Polkinghorne, Jennifer P Craig
雑誌名: Clin Experiment Ophthalmol. 2004 Apr;32(2):159-63. doi: 10.1111/j.1442-9071.2004.00003.x.
Abstract/Text BACKGROUND: The incidence of retinal detachment in New Zealand is not currently documented in the literature. This study sought to determine the annual incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors in northern New Zealand.
METHODS: Epidemiological and clinical data were collected for all patients presenting with a RRD in a 12-month interval in a confined geographical area of New Zealand.
RESULTS: One hundred and forty-one patients presented between May 1997 and April 1998 with a RRD. Five patients presented with bilateral RRD. The mean age at presentation was 53.9 years and the annual incidence for RRD was 11.8 cases per 100,000 people. RRD was more common in males than in females (1.3:1). Ocular trauma, high myopia and cataract extraction were found to be significant risk factors in the development of RRD.
CONCLUSIONS: The annual incidence of RRD in northern New Zealand is comparable to values reported for other parts of the world and, consistent with previous studies, the incidence of RRD was found to increase with age, and in association with trauma, high myopia and cataract surgery.

PMID 15068432  Clin Experiment Ophthalmol. 2004 Apr;32(2):159-63. doi:・・・
著者: W R Freeman, D N Friedberg, C Berry, J I Quiceno, M Behette, S C Fullerton, D Munguia
雑誌名: Am J Ophthalmol. 1993 Dec 15;116(6):713-20.
Abstract/Text We studied 259 patients to determine the time-dependent risk and risk factors for the development of retinal detachment in patients with cytomegalovirus retinitis. The six-month and one-year retinal detachment rates (by eye) were 11% and 24%, respectively. Increasing retinal surface involvement outside of the posterior pole and the presence of retinitis activity were found to be the two covariates that best predicted retinal detachment. Eyes with peripheral involvement greater than 25% had a fivefold risk for detachment, compared to eyes with 10% involvement. If there was retinitis activity and more than 25% peripheral (external to major vascular arcades) involvement, the risk increased to 24-fold. The presence of a fellow eye with retinal detachment was not an independent risk factor. These observations should help in the design of a prophylactic trial intended to prevent retinal detachment and should also help ophthalmologists counsel patients with cytomegalovirus retinitis.

PMID 8250074  Am J Ophthalmol. 1993 Dec 15;116(6):713-20.
著者:
雑誌名: Am J Epidemiol. 1993 Apr 1;137(7):749-57.
Abstract/Text The objective of this case-control study of idiopathic retinal detachment was to evaluate previously suggested hypotheses about risk factors for retinal detachment and to investigate whether new ocular or systemic risk factors could be identified. Between 1986 and 1990, data were obtained at five US clinical centers on 253 patients with idiopathic retinal detachment and 1,138 controls. Patients with pathologic myopia were excluded. Data were collected from interviews, clinical examinations, and laboratory analyses of blood samples. Only one clearly relevant risk factor, myopia, emerged from the analyses. An eye with a spherical equivalent refractive error of -1 to -3 diopters had a fourfold increased risk of retinal detachment compared with a nonmyopic eye; if the refractive error was greater than -3 diopters, the risk was increased 10-fold. The data suggest that almost 55% of nontraumatic detachments in eyes without previous surgery are attributable to myopia. The etiology of retinal detachment appears to be related to the architecture of the eye. The study found no evidence that systemic factors, particularly cardiovascular factors, play a role.

PMID 8484366  Am J Epidemiol. 1993 Apr 1;137(7):749-57.
著者: M Ivanisević
雑誌名: Ophthalmologica. 1997;211(2):90-2.
Abstract/Text In this study, the late secondary changes of the eye in long-standing, untreated rhegmatogenous retinal detachment (RRD) were examined. The most common complications were cataract (61.1%), strabismus (45.5%), toxic uveitis (27.3%) and development of proliferative vitreoretinopathy (100.0%). Complete loss of vision was found in all cases. Maximal visual acuity was hand motion, but only in 9.1% of cases. In the late follow-up period of untreated RRD, anatomic changes of the eye, permanent loss of vision and esthetic defects will appear.

PMID 9097312  Ophthalmologica. 1997;211(2):90-2.
著者: T Hida, Y Tano, S Okinami, N Ogino, M Inoue
雑誌名: Jpn J Ophthalmol. 2000 Jul-Aug;44(4):407-18.
Abstract/Text PURPOSE: Epidemiological and clinical study of retinal detachment associated with atopic dermatitis.
METHODS: A multicenter retrospective study.
RESULTS: We analyzed the records of 417 eyes of 348 patients operated on during 5 years from 1989 to 1993 and followed up for more than 6 months by vitreo-retinal specialists in 33 hospitals throughout Japan. The number of eyes operated on increased yearly from 42 in 1989 to 132 in 1993. These cases associated with atopic dermatitis were 2.3% of the average number of eyes operated on for rhegmatogenous retinal detachment during the same period, but when restricted to the Kanto area or further to Tokyo only, the percentage was as high as 3.8% and 4.7%, respectively.
CONCLUSION: Clinical characteristics of retinal detachment previously reported, such as traumatic slapping or rubbing of the lids by patients as the most likely pathogenetic factor, and high incidence of cataract and proliferative vitreoretinopathy, were confirmed. The primary surgical procedure was scleral buckling in 78% of the cases and vitreous surgery in 22%, and initial and final reattachment rates were 75.3% and 92.6%, respectively.

PMID 10974298  Jpn J Ophthalmol. 2000 Jul-Aug;44(4):407-18.
著者: H Hayashi, C Igarashi, K Hayashi
雑誌名: Br J Ophthalmol. 2002 Aug;86(8):898-901.
Abstract/Text AIM: To determine the frequency of ciliary body or retinal breaks and retinal detachment in eyes with atopic cataract.
METHODS: The records of 106 eyes (74 patients) with atopic cataract that underwent cataract extraction were reviewed. The frequency of ciliary body or retinal breaks and retinal detachment was classified by their presence preoperatively and postoperatively, and by cataract type.
RESULTS: Breaks were detected preoperatively in 27 eyes (25.5%) of 17 patients in the ciliary body (20 eyes, 18.9%), near the ora serrata (five eyes, 4.7%), and in undefined locations (two eyes, 1.9%). Among these, 16 eyes (15.1%) had already developed retinal detachment. After surgery, a ciliary body break occurred in one eye (0.9%) and retinal detachment in four eyes (3.8%) of three patients. The breaks that caused postoperative retinal detachment were in the ciliary body. When classified by cataract type, the highest frequency of breaks was associated with mature cataracts (35.0%), and all eyes with breaks developed retinal detachment.
CONCLUSIONS: One fourth of eyes with atopic cataract had breaks in the ciliary body or ora serrata, or retinal detachment preoperatively. The highest frequency of either breaks or retinal detachment was associated with mature cataract. The frequency of breaks or detachment that occurred postoperatively (approximately 5%) was lower than that present preoperatively.

PMID 12140212  Br J Ophthalmol. 2002 Aug;86(8):898-901.
著者: S Okinami, M Matsumura, H Ishigooka, Y Tanaka
雑誌名: Nippon Ganka Gakkai Zasshi. 1980 Jan 10;84(1):63-8.
Abstract/Text
PMID 7377038  Nippon Ganka Gakkai Zasshi. 1980 Jan 10;84(1):63-8.
著者: Christine R Gonzales, Anurag Gupta, Steven D Schwartz, Allan E Kreiger
雑誌名: Ophthalmology. 2004 Mar;111(3):518-21. doi: 10.1016/j.ophtha.2003.06.011.
Abstract/Text OBJECTIVE: To determine how often the fellow eyes of patients with rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy (PVR) harbor vision-threatening conditions at presentation and during follow-up.
DESIGN: Retrospective, observational case series.
PARTICIPANTS: Two hundred forty-eight patients with RRD without PVR were studied.
INTERVENTION: The authors observed the fellow eye of patients with RRD for vision-threatening pathology.
MAIN OUTCOME MEASURE: Detection of vision-threatening pathology in the fellow eye of patients with RRD without PVR.
RESULTS: Two hundred forty-eight patients were observed for an average of 5.2 years. One hundred fifty-seven vision-threatening events or diagnoses occurred in the fellow eye, including pre-existing and newly diagnosed conditions, 97 (62%) of which were rhegmatogenous in nature. Fifty-six patients (23%) had retinal detachments in their fellow eye, including those with a history of RRD repair (28 eyes), those presenting with bilateral RRD (4 eyes), and those developing new RRD during follow-up (24 eyes). In addition, 1 patient developed recurrent retinal detachment in the fellow eye during follow-up. Retinal tears were diagnosed and treated with laser retinopexy or cryotherapy in 30 (12%) fellow eyes (4 before the initial examination, 7 upon initial examination, and 19 on follow-up). Lattice degeneration was present in 27 (11%) fellow eyes.
CONCLUSIONS: Patients who develop RRD are at considerable risk for developing vision-threatening events, particularly rhegmatogenous events, in the fellow eye.

PMID 15019329  Ophthalmology. 2004 Mar;111(3):518-21. doi: 10.1016/j.o・・・
著者: D Mitry, J Singh, D Yorston, M A Rehman Siddiqui, A L Murphy, A F Wright, B W Fleck, H Campbell, D G Charteris
雑誌名: Br J Ophthalmol. 2012 Jan;96(1):110-3. doi: 10.1136/bjo.2010.194852. Epub 2011 Mar 3.
Abstract/Text AIM: To characterise the predisposing pathology and clinical features in the fellow eyes of patients recruited as part of the Scottish Retinal Detachment Study.
METHODS: The Scottish Retinal Detachment Study was a 2-year prospectively recruited population-based epidemiology study that sought to recruit all incident cases of primary rhegmatogenous retinal detachment (RRD) in Scotland.
RESULTS: A total of 1202 incident cases of primary RRD were recruited in Scotland, over a 2-year period and in 94% (1130 cases) detailed data on the clinical features of fellow eyes with RRD were available. Full-thickness retinal breaks were found in 8.4% (95/1130) of fellow eyes on presentation. Lattice degeneration was present in 14.5% (164/1130) of fellow eyes. Thirteen per cent (148/1130) of affected fellow eyes had a best corrected visual acuity of 6/18 or worse with previous RRD, the second most common cause of poor vision. Overall, 7.3% (88/1202) of cases had RRD in both eyes; 60% of cases with consecutive bilateral RRD presented before the macula were affected.
CONCLUSIONS: Rhegmatogenous pathology in the fellow eye represents an important threat to vision. Fellow-eye detachments are more common in pseudophakic individuals and those with a more myopic refractive error. Fellow-eye RRD has a greater likelihood of prompt presentation.

PMID 21378003  Br J Ophthalmol. 2012 Jan;96(1):110-3. doi: 10.1136/bjo・・・
著者: Shlomit Schaal, Mark P Sherman, Charles C Barr, Henry J Kaplan
雑誌名: Retina. 2011 Sep;31(8):1500-4. doi: 10.1097/IAE.0b013e31820d3f55.
Abstract/Text PURPOSE: To compare functional and anatomical outcomes of modern methods of repair of primary retinal detachment.
MATERIALS AND METHODS: Retrospective interventional comparative case series. A total of 1,226 patients with primary retinal detachment were included in the study. All patients completed 1-year follow-up and were divided into 4 groups: 322 patients underwent scleral buckling surgery, 442 patients underwent pars plana vitrectomy surgery, 316 patients underwent a combination of scleral buckling and vitrectomy surgery, and 56 patients underwent pneumatic retinopexy surgery for the primary repair of retinal detachment. Reattachment success rates, pre- and postoperative visual acuity, complications, and change in refractive error were reviewed.
RESULTS: Initial success rate for retinal reattachment was 86% for scleral buckling only, 90% for vitrectomy only, 94% for the combination of scleral buckling and vitrectomy, and 63% for pneumatic retinopexy surgery. Although patients undergoing pneumatic retinopexy had a lower initial success rate, there was no statistically significant difference in initial reattachment rates between the other three groups. There was no statistically significant difference in final visual acuity between the four groups. Complication rates varied among the techniques used.
CONCLUSION: Postoperative visual acuity at 1 year did not differ among the various techniques used to repair primary rhegmatogenous retinal detachments. However, scleral buckling, vitrectomy, or a combination of both resulted in an initially better anatomical success rate and fewer operative procedures than pneumatic retinopexy.

PMID 21606887  Retina. 2011 Sep;31(8):1500-4. doi: 10.1097/IAE.0b013e3・・・
著者: Kenneth M P Yee, J Sebag
雑誌名: Br J Ophthalmol. 2011 Dec;95(12):1728-30. doi: 10.1136/bjophthalmol-2011-300114. Epub 2011 Sep 6.
Abstract/Text AIMS: The long-term results of office-based pneumatic retinopexy (PR) using only filtered air were evaluated in a case series of rhegmatogenous retinal detachments with more than 3 years of follow-up, on average.
METHODS: 77 cases of primary rhegmatogenous retinal detachments arising from superior tears (mean=1.6 tears) were treated with cryopexy (n=61) or laser (next day, n=16) and intravitreal injection of pure air in an office setting. The macula was detached preoperatively in 37 eyes (48.1%). Outcome measures were single-operation success, final reattachment rates and visual acuity (VA).
RESULTS: Subjects were followed for 6-186 months (mean follow-up = 40.7 months, 46.8% ≥ 2 years, 25% ≥ 5 years). In all cases, the air bubble was gone within 5 days. Single-operation success was achieved in 62/77 (80.5%) eyes. Repeat PR was successful in four cases, increasing the PR reattachment rate to 85.7%. Scleral buckle was performed on the remaining 11 eyes (14.3%), 1 with vitrectomy. The final reattachment rate was 100%. VA improved ≥ 2 Snellen lines in 53.2% of patients, with 50/77 (64.9%) attaining VA ≥ 20/40. Following PR, 87% of subjects had the same or better VA.
CONCLUSIONS: Office-based pure-air PR achieves acceptable reattachment rates with good visual outcomes and long-term efficacy. Eliminating the need for expansile gases makes this approach more widely available, decreases recovery time and lowers healthcare costs.

PMID 21900226  Br J Ophthalmol. 2011 Dec;95(12):1728-30. doi: 10.1136/・・・
著者: Michael J Davis, Sachin S Mudvari, Susan Shott, Kourous A Rezaei
雑誌名: Arch Ophthalmol. 2011 Feb;129(2):163-6. doi: 10.1001/archophthalmol.2010.352.
Abstract/Text OBJECTIVES: To review characteristics and outcomes of patients who underwent primary pneumatic retinopexy (PR) for repair of rhegmatogenous retinal detachment in a multioffice retina practice and to determine what preoperative characteristics were associated with success or failure of PR.
METHODS: A retrospective medical record review was conducted of patients who underwent primary PR from September 2001 to March 2009. Patients with less than 6 months of follow-up were excluded. Data collected on each patient included age, sex, affected eye, preoperative visual acuity, lens status, presence of posterior vitreous detachment, presence of vitreous hemorrhage, macular status, presence of lattice degeneration, number and location of retinal breaks, clock hour extent of detachment, final visual acuity, final retinal status, number of procedures to reattach retina, and duration of follow-up.
RESULTS: Two hundred thirteen patients were included. The mean age was 59.3 years and 53.5% were male. Mean follow-up was 24.6 months, and 64.8% of patients had a successful PR. Vitreous hemorrhage and retinal detachment greater than 4.5 clock hours were the 2 factors that significantly affected successful outcome (P = .04 and .01, respectively). The overall mean final visual acuity was 20/40, with a mean of 20/30 in the success group and a mean of 20/60 in the failure group (P < .001).
CONCLUSIONS: Pneumatic retinopexy is a treatment option for certain types of rhegmatogenous retinal detachment. In patients with vitreous hemorrhage and detachments greater than 4.5 clock hours, the success rate may be lower. Final visual acuity is better with successful reattachment with a single procedure.

PMID 21320960  Arch Ophthalmol. 2011 Feb;129(2):163-6. doi: 10.1001/ar・・・
著者: Efstratios Mendrinos, Nathalie P Dang-Burgener, Alexandros N Stangos, Jorg Sommerhalder, Constantin J Pournaras
雑誌名: Am J Ophthalmol. 2008 Jun;145(6):1063-1070. doi: 10.1016/j.ajo.2008.01.018. Epub 2008 Mar 14.
Abstract/Text PURPOSE: To report the anatomic and functional results of primary vitrectomy without scleral buckling for the treatment of pseudophakic rhegmatogenous retinal detachment (PsRD).
DESIGN: Prospective, nonrandomized surgical technique study.
METHODS: One hundred eyes of 98 patients with PsRD were operated by vitrectomy alone. Internal subretinal fluid drainage, cryocoagulation and/or endolaser and fluid-air exchange with sulfur hexafluoride 20% was applied in all cases. The preoperative and postoperative characteristics were analyzed. Main outcome measures were anatomic success rates after initial surgical intervention and after reoperation for primary failures, visual outcome at the last follow-up visit, and complications.
RESULTS: Mean follow-up +/- standard deviation (SD) was 12 +/- 6.3 months (range, seven to 36 months). Mean final visual acuity +/- SD was 0.42 +/- 0.45 logarithm of the minimum angle of resolution (logMAR) compared with 0.95 +/- 0.73 logMAR before surgery (P < .01). Mean number +/- SD of retinal breaks found before surgery was 1.36 +/- 1.12 (range, zero to five), and an additional 1.58 +/- 2.26 (range, zero to 15) retinal breaks were found during surgery. The retina was reattached successfully after a single surgery in 92 eyes (92%). Recurrence of retinal detachment occurred in eight eyes (8%), caused by proliferative vitreoretinopathy in six eyes (75%) and by new breaks in two eyes (25%). Final anatomic reattachment was obtained in these cases after a mean of 1.75 subsequent operations. Three eyes required permanent silicone oil tamponade so that final anatomic success was achieved in 97 eyes (97%). The most common postoperative complication was ocular hypertonia of more than 21 mm Hg, observed in 36 (36%) eyes, which was managed successfully.
CONCLUSIONS: Primary vitrectomy without scleral buckling provides a high anatomic success rate in eyes with PsRD and is associated with few complications.

PMID 18342828  Am J Ophthalmol. 2008 Jun;145(6):1063-1070. doi: 10.101・・・
著者: Heinrich Heimann, Xiulan Zou, Claudia Jandeck, Ulrich Kellner, Nikolaos E Bechrakis, Klaus-Martin Kreusel, Horst Helbig, Lothar Krause, Andreas Schüler, Norbert Bornfeld, Michael H Foerster
雑誌名: Graefes Arch Clin Exp Ophthalmol. 2006 Jan;244(1):69-78. doi: 10.1007/s00417-005-0026-3. Epub 2005 Jul 26.
Abstract/Text BACKGROUND: Primary pars plana vitrectomy (PPPV) has gained widespread popularity in the treatment of rhegmatogenous retinal detachments (RRD). However, the surgical procedure is still flawed by a significant rate of anatomical and functional failures. The study was conducted to analyse the risk factors for a dissatisfying postoperative outcome.
METHODS: We carried out a retrospective study of 512 cases of PPPV with a minimum follow-up of 3 months from one institution over a 9-year period. Preoperatively, 24.8% of patients (127 out of 512) were pseudophakic, 16.4% (84 out of 512) highly myopic, 19.9% (102 out of 512) had preoperative proliferative vitreoretinopathy (PVR) and 14.6% (75 out of 512) had vitreous haemorrhage.
RESULTS: The follow-up period ranged from 3 to 108 months (median 14.8). Retinal reattachment was achieved with one operation in 70.7% (362 out of 512) and after one or more operations in 97.5% of cases (499 out of 512). The major reasons for redetachments were new retinal breaks, followed by a combination of new breaks and PVR, and PVR without apparent breaks. Postoperative visual acuities of > or =0.1 and > or =0.4 were achieved in 82.8% (424 out of 512) and 48.2% (247 out of 512) respectively. Out of 376 phakic patients at study entry, 66.4% (250 out of 376) underwent cataract surgery either in combination with PPPV or during the postoperative course. Factors that were significantly associated with either anatomical or functional failure included duration of symptoms, low preoperative visual acuity, myopia, amblyopia, hypotony, macular detachment, preoperative PVR, extent of detachment, involvement of inferior quadrants, no detectable breaks, large breaks, breaks posterior to the equator, surgeon, level of surgical training, endocryotherapy, and combined scleral buckling surgery.
CONCLUSION: Primary pars plana vitrectomy is still flawed by a relatively high primary redetachment rate following the initial procedure. The advantages of the technique are a high final reattachment rate and relatively good functional results in a subset of patients with more complicated types of RRD. The risk factors for postoperative failures following PPPV for RRD match to a large extent those following scleral buckling surgery (SBS). Future improvements of the technique will have to focus on modifiable risk factors, such as details of the surgical procedures, surgical training and case selection, to distinguish it from SBS.

PMID 16044327  Graefes Arch Clin Exp Ophthalmol. 2006 Jan;244(1):69-78・・・

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