| Objective To investigate the effect of scleral buckling combined with intravitreal gas injection on the residual rate and duration of submacular fluid(SMF)in rhegmatogenous retinal detachment and the effect of SMF on visual prognosis.Methods Prospective non randomized controlled study.From August 2019 to February 2020,57 eyes of 57 patients with macular-off rhegmatogenous retinal detachment were enrolled in the study.All patients were informed and signed the consent of the research and operation.The patients were divided into group A(scleral buckling combined with intravitreal gas injection,24 eyes)and group B(scleral buckling alone,33 eyes).Group A kept prone position for 24 hours after the operation,while group B kept proper position to make the hole in the highest position after operation.Complete ophthalmic examinations including preoperative and postoperative best corrected visual acuity(BCVA),slit lamp,fundus,optical coherence tomography(OCT)and intraocular pressure(IOP).The residual rate and duration of SMF,BCVA,submacular fluid height(SMFh),central retinal thickness(CRT),intraocular pressure and postoperative complications were compared between the two groups.Results The residual rate of SMF in group A was lower than group B;In group A,the 75 th percentile of SMF duration was 2 days,and the mean duration was 19.1 days(95% confidence interval,3.6-34.7 days);in group B,the 75 th percentile of SMF duration was 90 days,and the mean duration was 126.8 days(95% confidence interval,108.7-145.0 days),the duration of SMF in group A was shorter than group B(P<0.05).The residual rate of SMF was 4.2% in group A and 60.6% in group B 6 months after operation.There were significant differences in SMFh and CRT between the two groups at 2 D,1 wk,1 mo,3 mo and 6 mo after operation(P<0.05).SMFH and CRT in group A were lower than those in group B.There was a significant difference in the main effect of time between the two groups(P<0.01),Both groups’ BCVA would gradually increase with the change of time;There was a significant difference in the main effect of operation mode and time(P<0.05),the interaction between operation mode and time was obvious,the change of BCVA between the two groups was significantly different after operation;There was no significant difference in the main effect of operation mode between the two groups.The operation method is not the main influencing factor of the increase of BCVA.Further pairwise comparison showed that there was significant difference in BCVA at 2d,1 mo and 3 mo after operation between the two groups(P<0.05),and there was no significant difference at 1wk and 6mo after operation(P>0.05).BCVA at 1 mo and 3 mo after operation in group A was better than group B,and there was no significant difference at 6 mo after operation between the two groups.There was no significant difference in the increase rate of BCVA between the two groups at2 d,1mo and 3mo after operation(P>0.05),but there was significant difference at 1 wk,1 mo and 6 mo after operation(P<0.05);In group B,the increase rate of BCVA increased from 2 days to 1 week after operation,and then decreased from1 to 3 months after operation.There were no significant difference in the rate of retinal reattachment(100% vs 100%),incidence of high intraocular pressure(16.7% vs 21.2%;0% vs 6.1%),incidence of vitreous opacity(16.7% vs 18.2%)and incidence of epimacular membrane(13.0% vs 12.1%)between the two groups 6mo after operation(P>0.05).There were no choroidal detachment,proliferative vitreoretinopathy(PVR),macular hole,posterior capsule opacification and other complications.Conclusions Scleral buckling combined with intravitreal gas injection can reduce the residual rate of SMF,shorten the duration of SMF,improve the postoperative visual acuity and reduce the complications.The effect of SMF on visual prognosis is delayed visual recovery,which may occur 1 to 3 months after surgery,but it may not affect the final best corrected visual acuity. |
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