G高速玻璃体切除手术治疗孔源性视网膜脱离初步临床观察.docVIP

23G高速玻璃体切除手术治疗孔源性视网膜脱离的初步临床观察 作者：刘志雄，吴国基，康克明，王晓波，陈惠婵 【摘要】 目的:探讨23G高速玻璃体切除手术治疗孔源性视网膜脱离的临床效果。方法:前瞻性选择200903/200910一组合并较明显玻璃体混浊、玻璃体视网膜粘连牵拉或合并玻璃体积血的孔源性视网膜脱离病例共20例20眼，应用23G玻璃体切除手术联合膨胀气体全氟丙烷(C3F8)填充。统计分析视网膜解剖复位率、术后3mo时最佳矫正视力、术中、术后并发症、手术时间及术后眼部刺激征的严重程度，术后平均随访6mo。结果：所有20眼均一次手术后视网膜完全复位。未发生器械损伤晶状体或医源性视网膜裂孔等术中并发症。15眼黄斑已脱离眼的术前最佳矫正视力为0.02～0.5 (logMAR视力为0.3～2.0，平均1.187±0.616)，术后3mo时最佳矫正视力为0.3～0.8 (logMAR视力为0.1～0.52，平均0.276±0.114)，差异具有统计学意义(t=5.756, Plt;0.01);5眼黄斑未脱离眼的术前最佳矫正视力为0.8～1.0 (logMAR视力为0～0.52，平均0.218±0.276)，术后3mo时最佳矫正视力为0.6～1.0 (logMAR视力为0～0.52，平均0.312±0.285)，差异没有统计学意义(t=1.0,P=0.374)。手术后未发生低眼压、脉络膜脱离或眼内炎等切口相关并发症，无增生性玻璃体视网膜病变(PVR)发生。3眼术后第1d出现轻度晶状体后囊下羽毛状混浊，1wk内消退。至随访结束时，4眼(20%)晶状体核密度增加，其余病例无新生白内障或原白内障明显加重。5眼(25%)术后一过性眼压升高，眼压均lt;30mmHg，经局部使用1～2种降眼压滴眼液，3d内恢复正常，平均术后第7d眼压为14.6±3.4mmHg。结论:23G玻璃体切除手术治疗孔源性视网膜脱离安全有效，缝合手术切口可避免并发症，是值得推广的技术。 【关键词】 玻璃体切除术/方法;视网膜脱离 　　Abstract 　　AIM: To investigate the outcome of primary 23gauge(23G) pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). 　　METHODS: In this prospective case series, 20 eyes of 20 consecutive patients with RRD underwent primary 23G PP with intraocular gas tamponade and sclerotomy suturing. Postoperative mean followup was 6 months. Main outcome measures included postoperative anatomical status, visual acuity, intraocular pressure, and operative complications. 　　RESULTS: The primary anatomical success rate was 100%. The mean postoperative visual acuity at postoperative month 3 improved from 0.020.5(logMAR was 1.187±0.616) to 0.30.8 (logMAR was 0.276±0.114) (t=5.756, Plt;0.001) and from 0.81.0 (logMAR was 0.218±0.276) to 0.61.0 (logMAR was 0.312±0.285) (t=1.0, P=0.374) in macularoff and macularon cases,respectively. No patients had hypotony or developed choroidal detachments, endophthalmitis, and PVR. Postoperative cataract progression occurred in 4 eyes(20%). Early ocular hypertension in 5 eyes was controlled with 12 kinds of antiglaucoma drops. 　　CONCLUSION: 23G PPV is an effective s