Irish Journal of Medical Science ( IF 1.7 ) Pub Date : 2023-10-24 , DOI: 10.1007/s11845-023-03549-6 Kealan McElhinney 1 , Robert McGrath 1 , Rory Holohan 1 , Zubair Idrees 1
Background
Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion—this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD).
Aims
To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting.
Methods
Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre.
Results
A total of 87 patients were identified—mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified—myopia (37%), recent trauma (2%), and RRD family history (5%).
All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%).
Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas.
Conclusion
A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.
中文翻译:
爱尔兰三级医院急诊氩激光视网膜固定术的 12 个月分析
背景
视网膜撕裂是由于视网膜和玻璃体粘连部位的牵引而发生的,这使得玻璃体后液进入视网膜下腔。需要及时治疗以防止进展为孔源性视网膜脱离(RRD)。
目标
旨在确定在紧急情况下采用激光视网膜固定术治疗视网膜撕裂后的术后结果。
方法
对 2021 年 1 月至 12 月期间在爱尔兰三级转诊中心科克大学医院接受紧急裂隙灯激光视网膜固定术的所有患者进行回顾性审查。
结果
总共确定了 87 名患者,平均年龄为 60 ± 12 岁,其中 54% 为女性。随访时间为 1 周至 11 个月。确定了诱发危险因素——近视(37%)、近期外伤(2%)和 RRD 家族史(5%)。
所有患者的眼部伤员均接受了裂隙灯激光视网膜固定术。 63 名患者(72%)有上裂,66 名患者(76%)有马蹄形视网膜撕裂,21 名患者(24%)有视网膜裂孔。相关发现包括晶格变性(26%)、视网膜下液(55%)和玻璃体出血(33%)。
14 名患者 (16%) 需要多次裂隙灯激光视网膜固定术,而 18 名患者 (21%) 需要玻璃体视网膜外科医生的干预,包括间接激光视网膜固定术 (3%)、冷冻疗法 (11%) 和睫状体平坦部玻璃体切除术。 6%)。在最近的随访中,所有患者都有解剖学上附着的视网膜。
结论
接受紧急激光视网膜固定术的患者中有相当一部分(21%)需要进一步干预。视网膜前部撕裂的患者将从与玻璃体视网膜外科医生的早期讨论中受益。建议将激光视网膜固定术和视网膜撕裂管理方面的部门培训作为持续质量改进的一部分。