| Sažetak | Cilj istraživanja: Cilj ovog znanstvenog rada bio je istražiti karakteristike i metode kirurškog liječenja regmatogenog odignuća mrežnice u bolesnika liječenih u Klinici za očne bolesti KBC-a Split tijekom trogodišnjeg vremenskog razdoblju (od 1. siječnja 2016. do 1. siječnja 2019. god.) te procijeniti njihov utjecaj na anatomski i funkcionalni uspjeh liječenja.
Materijali i metode: Ovom retrospektivnom studijom obuhvaćeni su svi bolesnici, njih 151, koji su u navedenom vremenskom razdoblju bili podvrgnuti jednom od tri vrste operativnog načina liječenja (pneumoretinopeksija, konvencionalna metoda i pars plana vitrektomija). Uvidom u medicinsku dokumentaciju dobiveni su podatci o životnoj dobi i spolu bolesnika, karakteristikama regmatogenog odignuća mrežnice (dolazna vidna oštrina, lokalizacija i proširenost odignuća, lokalizacija, veličina i broj retinalnih ruptura, stanje staklastog tijela, prisutnost perifernih degeneracija, stanje makule i leće), vremenu trajanja odignuća i vrsti operacijskog zahvata te je procjenjivan njihov utjecaj na anatomski i funkcionalni ishod liječenja.
Rezultati: Medijan životne dobi bolesnika bio je 63 godine (Q1-Q3: 54-70; min-maks: 18-88 godina). Ukupno je bilo 90 (60%) muškaraca i 61 (40%) žena. Muškarci i žene nisu se statistički značajno razlikovali prema životnoj dobi (Z=0,410; P=0,682). Od 151 operiranog bolesnika 130 (86%) je bilo uspješno operirano, a u 21 (14%) bila je potrebna ponovna operacija. Ukupna kumulativna incidencija regmatogenog odignuća mrežnice za navedeno trogodišnje razdoblje u Splitsko-dalmatinskoj županiji bila je 43 (95%CI: 36-50) na 100 000 stanovnika za životnu dob od 18 do 88 godina. Izgled neuspješnih u odnosu na uspješne operacije za 3,4 puta je veći u skupini bolesnika u kojih su tegobe trajale jednako i više od 15 dana u odnosu na ispitanika čije su tegobe trajale manje od 15 dana (OR=3,4; 95%CI: 1,3-9,3). Izgled za uspjeh operacije, u odnosu na neuspjeh, za 3,5 puta je veći u skupini bolesnika u kojih je ruptura prijeoperacijski pronađena nego u skupini bolesnika u kojih ruptura nije nađena (OR=3,5; 95CI: 1,2-10). Analizom vidne oštrine prije i nakon operacije (Wilcoxon Signed Ranks test) dobili smo statistički značajno poboljšanje poslijeoperacijske konačne vidne oštrine u odnosu na prijeoperacijsku (Z=6,1; P<0,001), iako je dobra vidna oštrina (jednaka i viša od 0,5) postignuta u samo 52 (34,4%) bolesnika. Konačna vidna oštrina negativno je korelirala s vremenom trajanja tegoba do operacije, a pozitivno s prijeoperacijskom vidnom oštrinom te je bila statistički značajno lošija u bolesnika s odignućem makule, pseudofaka i onih operiranih pars plana vitrektomijom u odnosu na druge dvije tehnike.
Zaključci: Istraživanje je pokazalo da dobar anatomski uspjeh nije pratio jednako tako dobar funkcionalni uspjeh. Iz rezultata rada može se zaključiti da je za uspjeh liječenja regmatogenog odignuća mrežnice nužan što raniji operacijski zahvat, osobito kada makula nije odignuta, kao i pažljiva lokalizacija svih ruptura, jer su to, uz izbor tehnike operacijskog zahvata, jedini čimbenici na koje se može utjecati u cilju poboljšanja ishoda liječenja. |
| Sažetak (engleski) | Objectives: The aim of this study was to investigate characteristics and surgical techniques for the repair of rhegmatogenous retinal detachment in patients treated in Department of Ophthalmology, University Hospital of Split during the 3 year period (from the 1st of January 2019 until the 1st January 2019) and to assess their influence on anatomical and functional success of the treatment.
Materials and methods: All 151 patients, who were treated by one of three surgical techniques (pneumoretinopexy, scleral buckling and pars plana vitrectomy) for the repair of rhegmatogenous retinal detachment during the observed period are included in this retrospective study. Medical records of all patients were reviewed for age and sex of patients, the characteristics of rhegmatogenous retinal detachment (visual acuity at presentation, localization and size of the lesion, localization, size and number of retinal tears, vitreous status, presence of peripheral degeneration, macula and lens status) and the duration of the detachment and types of surgical techniques. All the collected data were analyzed and their influence on anatomical and functional outcome of the treatment has been evaluated.
Results: The median age of the patients was 63 years (range, 18-88 years). There were 90 (60%) males and 61 (40%) females. There was not statistically significant difference between males and females according to their age. (Z=0.410, P=0.682). Of all 151 operated patients, 130 (86%) were successfully operated, and in 21 patients (14%), another surgical procedure was required. The total cumulative incidence of rhegmatogenous retinal detachment for the three-year period in the Split-Dalmatia County was 43 (95%CI: 36-50) per 100,000 of population aged 18 to 88 years. The outcome of unsuccessful in relation to the successful operation was 3.4 times higher in the group of patients with the duration of symptoms equal or more than 15 days, compared to subjects whose symptoms lasted less than 15 days (OR=3.4; 95%CI: 1.3-9.3). The success rate of the operation compared to the failure, was 3.5 times higher in the group of patients in whom the retinal tears were preoperatively found than in the group in which the tears were not found (OR=3.5; 95%C1: 1.2-10). A statistically significant improvement was achieved in final visual acuity compared to visual acuity on presentation (analyzed by Wilcoxon Signed Ranks test), although good visual acuity (equal to higher than 0.5) was achieved in only 52 (34.4%) patients. The final visual acuity was statistically significantly associated with the duration of the symptoms before the surgical procedure, the macula status, the type of surgery, the preoperative lens status and the preoperative visual acuity.
Conclusions: The results showed that good anatomical success was not followed by equally good functional success. It can be concluded that the success rate of treating rhegmatogenous retinal detachment mostly depends on early surgical procedure (especially in the case when the macula has not been detached yet), as well as localization of all retina breaks because these are the only factors (beside the choice of surgical techniques) that can be modified in order to improve the outcomes of the treatment. |
