Izhodišča: Ovrednotili smo anatomski in funkcionalni izid zdravljenja kompleksnega regmatogenega odstopa mrežnice z vitrektomijo pars plana (PPV).
Metode: V retrospektivno raziskavo smo vključili 88 ...oči 88 bolnikov, ki so bili zaradi kompleksnega regmatogenega odstopa mrežnice zdravljeni s PPV. Določili smo anatomski uspeh in funkcionalni izid na podlagi korigirane vidne ostrine (VO) v celotni skupini bolnikov in v skupinah glede na status očesne leče, rumene pege in prisotnosti proliferativne vitreoretinopatije (PVR) stopnje ≥ C1. Z optično koherenčno tomografijo (OCT) rumene pege smo vsaj 6 mesecev po PPV ovrednotili prisotnost prekinitev elipsoidne cone, cistoidnega makularnega edema (CME), epiretinalne membrane (ERM) ali makularne luknje.
Rezultati: Anatomski uspeh je bil po primarni PPV 93,2 %. Končni anatomski uspeh je bil dosežen pri vseh 88 bolnikih (100 %). Korigirana VO se je statistično značilno izboljšala iz VO 1,7 ± 1,2 SD logMAR pred operacijo na VO 0,6 ± 0,7 SD logMAR po operaciji (p=0,01). Med skupinama bolnikov je glede na prisotnost PVR izstopal slabši anatomski izid v skupini s PVR stopnje ≥ C1 (89,7 %). Korigirana VO se je po operaciji izboljšala pri vseh skupinah bolnikov, vendar po analizi glede na skupine statistično značilno le v skupini fakih (p=0,019), z odstopom rumene pege, (p=0,016) in s prisotnim PVR stopnje ≥ C1 (p=0,028). Končna VO je bila boljša v skupini psevdofakih (0,75 ± 1,06), v skupini bolnikov z ležečo rumeno pego (0,78 ± 1,30) in pri bolnikih brez PVR (0,80 ± 1,15 logMAR). Analiza OCT rumene pege po operaciji je pokazala prisotnost prekinitev elipsoidne cone v 39 %, CME v 15 %, ERM v 2 % in makularne luknje v 2 %. Primerjava spremenljivk OCT glede na skupine na podlagi statusa očesne leče, rumene pege in prisotnosti PVR stopnje ≥ C1 je pokazala največji delež prekinitev elipsoidne cone v skupini oči s prisotnim PVR stopnje ≥ C1 (58,6 %).
Zaključek: Ugotovili smo visoko stopnjo anatomske in funkcionalne uspešnosti zdravljenja kompleksnega regmatogenega odstopa mrežnice z vitrektomijo. Funkcionalni izid je bil boljši pri bolnikih z umetno znotrajočesno lečo, pri bolnikih z ležečo rumeno pego in pri bolnikih brez PVR. Največji delež bolnikov s prekinjeno elipsoidno cono je bil v skupini bolnikov s predoperativno PVR.
Background: The consequence of prenatal detection of fetuses with congenital anomalies is induced ter- mination of pregnancy (TOP). The analysis of the indications for TOP and the agreements between ...prenatal and pathohistological findings is required to assess the quality of work and the appropriateness of diagnostic procedures. Methods: This retrospective analysis involved the indications for TOP performed for congenital fetal anomalies between January 2005 and March 2009. The TOP cases were divided into two groups: the early (up to 22 week, abortion) and the late (≥ 22 weeks 0/7, delivery) termina- tion group. With regard to the agreement between prenatal and pathohistological postmor- tem findings, 3 groups were created: complete agreement, agreement with additional data provided by pathohistological analysis, disagreement of findings. Results: Of the 220 cases of TOP for congenital anomalies, 180 (82 %) were abortion cases and 40 (18 %) were labour cases. In both groups, the most frequent causes for TOP were fetal structural abnormalities that were not due to chromosomal anomalies (102 (57 %) in the abortion group and 38 (95 %) in the delivery group). The percentage of chromosomal/monogenic anomalies was statistically significantly higher in the abortion (43 %) than in the labour group (only 5 %) (p < 0.001). Pathohistological examination was performed in 172 cases. In 126 (73 %) cases the agreement between prenatal ultrasound and pathohistological find- ings was complete and in 37 (22 %) pathohistological findings provided additional data on congenital anomalies that did not change the prenatally made diagnosis and would not affect the management of pregnancy. In none of the cases did pathohistological findings reject the prenatally made diagnosis. Conclusions: Fetal structural anomalies are frequent cause of TOP. Pathohistological examination of the fetus confirmed the prenatal diagnosis in all the cases, whereas in one fourth of the cases it provided additional information on congenital anomalies.
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