23G微创玻璃体切割术在玻璃体视网膜疾病中的应用

目的:探讨23G经结膜无缝合玻璃体切割系统在玻璃体视网膜疾病中的应用,观察其疗效以及并发症情况。方法:回顾性分析2011年10月至2013年10月行23G玻璃体切割术的患者46例(48眼)。其中,特发性黄斑裂孔8眼(16.7%),特发性黄斑前膜5眼(10.4%),玻璃体积血19眼(39.5%),糖尿病视网膜病变V-VI期8眼(16.7%),孔源性视网膜脱离8眼(16.7%)。分别观察缝合组和未缝合组手术前和手术后1d、7d、1个月眼压变化情况、手术效果、时间、最佳矫正视力及术中、术后并发症等。术后随访1~12个月。结果:所有病例均顺利完成手术,巩膜切口缝合组和未缝合组间术后1d、7d、1个月眼压差异均无统计学意义(P0.05);术后最佳矫正视力均有不同程度提高,与术前比较差异有统计学意义(P0.01)。手术时间70.12±7.86 min;术后眼部刺激症状轻微,术后并发症少见。术中2眼套管滑脱,5眼结膜下轻微出血,3眼结膜下气泡,所有病例在随访期间无严重并发症发生。结论:23G玻璃体切割术具有微创、手术时间短等优点,术后恢复快,疗效好,并发症少,将其应用于治疗玻璃体视网膜病变是一种安全有效的微创手术方法。

Application of 23-gauge Micro-invasive Vitrectomy for Vitreoretinopathy Disease

Objective： To investigate the application of 23-gauge transconjunctival sutureless vitrectomy system （23-GTVS）in the treatment of vitreoretinopathy disease and evaluate the efficacy,safety and complications. Methods： A 48 cases of 23-GTVS in our hospital from October 2011 to October 2013 was conducted retrospective analysis,including 8 eyes of idiopathic macular hole （16.7%）, 5 eyes of idiopathic macular epiretinal membrane （ 10.4% ）,19 eyes of vitreous hemorrhage （29.5%） , 8 eyes of peripheral diabetic retinopathy （PDR stage V-VI） （16.7%） and8 eyes of rhegmatogenous retinal detachment （RRD） （16.7%）.Intraocular pressure preoperative as well as 1 day,7 days and 1 month postoperative, surgical effects, surgical time, best corrected visual acuity and complications were observed both in suture group and non-suture group. The follow-up time was from 1 month to 12 months. Results： All cases were successfully completed operation and there were no statistical differences in intraocular pressure of different time points between two group （P〉0.05）. Best corrected visual acuities postoperative both improved in two groups （P〈0.01）. The mean surgery time was 70.12± 7.86 min and there was few complication found. The intraoperative complications included 2 cases of slippage of intubation tube in,5 cases of slight hemorrhage under conjunctiva and 3 cases of bubble under conjunctiva.No serious postoperative complication was observed during the follow-up time in all cases. Conclusion： 23-GTVS, showing shorter operative-time,faster postoperative recovery,better curative effect and rare complications, was an effective and safe surgical technique in the management of vitreoretinopathy disease.