25G经结膜免缝合玻璃体切割系统用于黄斑部手术的实用性和安全性研究

目的探讨25G经结膜免缝合玻璃体切割系统(TSV25G系统)用于黄斑部手术的实用性和安全性，总结初步的临床经验。方法应用TSV25G系统手术治疗16例黄斑疾病患者，其中黄斑前膜9例，特发性黄斑裂孔3例，外伤性黄斑裂孔2例，玻璃体黄斑牵引综合征2例。其中男11例，女5例，年龄14岁～72岁。手术应用TSV25G系统，切割速率1500次／min，灌注瓶高度40～50cm，吸引负压为550mmHg，手术中眼压维持在29～35mmHg。术后随访1～12个月。结果16例患者均顺利完成手术，手术时间28～56min，平均手术时间37min。建立手术“三通道”所需要的时间平均为84秒，关闭手术切口需要的时间平均为32秒。内眼操作结束后3例患者4个穿刺口漏水，经从原穿刺口注射1～2ml消毒空气后3个穿刺口泄漏停止，1个穿刺口仍漏水，用6—0可吸收缝线缝合。手术后平均住院时间为5天，14例术后视力提高，其中5例患者视力恢复到0．8以上，2例视力变化，8例患者视物变形消失，3例视物变形减轻，无手术并发症。结论TSV25G系统应用于黄斑疾病手术治疗安全实用，简化了玻璃体切割手术操作，减少了手术损伤，缩短了手术时间，减少了手术后炎症反应，病人恢复快。     

应用25G经结膜无缝合玻璃体切割手术系统治疗黄斑裂孔

目的评估应用25G经结膜无缝合玻璃体切割手术系统（TSV205G）治疗黄斑裂孔的疗效及手术实用性。方法回顾分析14例14眼行TSV25G玻璃体切割手术治疗的黄斑裂孔患者的临床资料。14例患者术前均未发生视网膜脱离，其中特发性黄班裂孔8例，外伤性黄斑裂孔4例，高度近视性黄斑裂孔2例。对以上患者应用TSV25G系统行玻璃体切除、剥离黄斑前膜和（或）内界膜、气液交换和15％全氟丙烷（C3F8）眼内填充等治疗。手术后随访1．5m～10m，平均4．2m，主要观察黄斑裂孔闭合情况、术后视力、术中及术后并发症。结果所有手术均在（30～50）分钟顺利完成。14例患者中9眼黄斑裂孔闭合，2眼直径缩小，2眼无变化，1眼出现黄斑裂孔性视网膜脱离。术后视力较术前提高者10眼，不变者2眼，下降者2眼。手术并发症主要为穿刺口漏气导致结膜下气肿及眼压偏低，需要补充注射气体以恢复眼压，此外未观察到其它并发症。结论TSV25G应用于黄斑裂孔的手术治疗具有手术时间短、创伤小、术后恢复快等优点，值得推广。     

应用25G经结膜无缝线玻璃体切割手术系统治疗黄斑前膜

目的 探讨TSV25G(25G经结膜无缝线玻璃体切割手术系统)治疗黄斑前膜的手术疗效及应用价值.方法 15例黄斑前膜,其中特发性黄斑前膜10例,继发性黄斑前膜5例,手术使用美国博士伦公司的Millennium玻璃体切割机与TSV25G系统,经结膜穿刺行玻璃体切割术,剥除黄斑前膜,平均手术时间27min,无玻璃体于小并发症.结果 术后11例患者视物变形消失,4例视物变形明显减轻,黄斑水肿或黄斑皱褶减退或明显减轻.结论 TSV25G治疗黄斑前膜疗效确切.     

表面麻醉下25G经结膜无缝合玻璃体视网膜手术的临床应用

目的 观察表面麻醉下行25G经结膜无缝合玻璃体视网膜手术的疗效、适应证和并发症。 方法 回顾分析22例爱尔卡因滴眼液表面麻醉下采用25G经结膜无缝合玻璃体切割手术系统（TSV25G）行玻璃体视网膜手术患者的临床及随访资料。22例患者均为单眼患病接受治疗。其中特发性黄斑裂孔10只眼，特发性黄斑前膜6只眼，玻璃体黄斑牵引综合征4只眼，视网膜分支静脉阻塞玻璃体积血2只眼。根据病情行视网膜前膜、黄斑前膜和（或）内界膜剥离，气液交换和全氟丙烷（C₃F₈）气体眼内充填 。手术后随访1~11个月，平均随访时间6.4个月。主要观察分析手术中的镇痛效果、患者合作程度、手术效果以及手术中和手术后并发症。 结果 所有手术眼均可在表面麻醉下顺利完成手术操作。手术时间20~25min，平均手术时间约22min。手术中患者无特别不适，能配合手术；手术后2d内手术创口结膜轻度水肿，7d后已无明显痕迹。1个月时仅在巩膜表面见一浅的色素沉着点。手术后一过性眼压升高2只眼，晶状体后囊羽毛状混浊5只眼，玻璃体积血1只眼，结膜下气泡2只眼。未发生感染性眼内炎、医源性视网膜裂孔及视网膜脱离、脉络膜脱离以及其他与切口相关的并发症。特发性黄斑裂孔患者9只眼裂孔闭合，1只眼裂孔缩小但未闭合，特发性黄斑前膜、玻璃体黄斑牵引综合征、视网膜分支静脉阻塞玻璃体积血均治愈。 结论 表面麻醉下的25G经结膜无缝合玻璃体视网膜手术具有手术操作简单、时间短、创伤小、并发症少、手术后恢复快等优点，主要适用于特发性黄斑裂孔、特发性黄斑前膜、玻璃体黄斑牵引综合征、单纯玻璃体积血等手术操作相对简单的疾病的玻璃体视网膜手术治疗。 （中华眼底病杂志，2004，20：133-136）     

25G经结膜无缝合玻璃体切割系统临床应用初步报告

目的 观察25G经结膜无缝合玻璃体切割系统（TSV25G）用于微创玻璃体切割手术的实用性和安全性，总结初步的临床经验。 方法 18例患者应用TSV25G进行微创玻璃体切割手术。记录建立手术“三通道”和关闭切口所需要的时间，观察手术前后的眼压、视力及手术后并发症。 结果 建立手术“三 通道”所需要的时间平均为1 min24s，关闭手术切口需要的时间平均为 32 s；手术前眼压平均为16.3 mm Hg（1 mm Hg=0.133 kPa），手术后第1天、1周、1个月时的平均眼压分别为13.0 、15.9、16.4 mm Hg。手术前和手术后1个月时的视力分别为手动/20 cm～0.2和手动/50 cm ～0.6；手术后无切口渗漏、眼内感染等并发症。 结论 应用TSV25G进行微创玻璃体切割手术简化了玻璃体切割手术操作，减少了手术损伤，缩短了手术时间，减少了手术后炎症反应，安全实用。（中华眼底病杂志，2004，20：139-141）     

继发性与特发性黄斑前膜的手术疗效分析

目的 探讨玻璃体视网膜手术后继发性黄斑前膜的影响因素，比较继发性黄斑前膜与特发性黄斑前膜的手术效果。 方法 分析26例黄斑前膜患者的26只眼（其中玻璃体视网膜手术后继发性黄斑前膜18只眼，特发性黄斑前膜8只眼）行玻璃体切割、黄斑前膜剥离等治疗前后的视力、眼底彩色照相以及部分患者的光相干断层扫描（optical coherence tomography，OCT）检查和随访3~12个月的临床资料。 结果 8例继发性黄斑前膜患者中，与手术有关者9例，占50.0%。巩 膜外冷凝、眼内激光光凝封闭巨大视网膜裂孔手术后继发黄斑前膜差异有显著性的意义（χ2=12.24，P＜0.05）。与玻璃体积血有关的继发性黄斑前膜11例，占61.1%。手术后3个月内视物变形消失者8例，占30.8%；视物变形改善者18例，占69.2% ；两组患者手术后视力均有明显提高。其中，继发性黄斑前膜患者手术后视力平均提高1.33行，最好矫正视力为0.6；特发性黄斑前膜患者手术后视力平均提高3行，最好矫正视力达0.8。 结论 巩膜外冷凝封闭巨大视网膜裂孔、手术前后伴玻璃体积血是玻璃体视网膜手术后继发黄斑前膜的高危因素。特发性黄斑前膜的手术疗效明显好于继发性黄斑前膜。 （中华眼底病杂志，2003，19：90-92）     

23G玻璃体切割手术在高海拔地区的应用

探讨23G玻璃体切割系统在高海拔地区玻璃体切割手术中的应用。 方法:对本院需行玻璃体切割的住院患者31例32眼采用23G玻璃体切割术,包括玻璃体积血、黄斑裂孔、黄斑前膜、晶状体后脱位、视网膜脱离、Tersonz综合征、玻璃体积血合并视网膜脱离。 结果:手术过程顺利,无需扩大巩膜穿刺口,手术后并发症主要是低眼压。 结论:23G经结膜无缝合玻璃体切割系统,与25G玻璃体切割比较效率更高,可以同20G一样处理周边部玻璃体视网膜,同时具有25G免缝合、愈合快、手术时间短、术后并发症少的优点,因此可在高海拔地区玻璃体切割手术中广泛应用。     

25G玻璃体切除手术系统在闭合性眼外伤玻璃体积血手术中的应用

目的评估25G经结膜无缝合玻璃体切除手术系统(TSV 25G)在闭合性眼外伤玻璃体积血手术治疗中的应用价值。方法回顾性分析应用TSV 25G治疗20例20眼闭合性跟外伤玻璃体积血的临床资料。结果20例中除1例外,余均顺利完成手术,手术时间30～44min,平均时间36min。1例术中穿刺口漏水,缝合1针。手术后住院时间3～7d,平均4.5d;12例视力恢复至0.8以上占60.00%,其余8例合并视神经视网膜脉络膜挫伤,视力也有不同程度的提高。结论TSV 25G应用于闭合性眼外伤玻璃体积血手术治疗,操作安全且手术时间短,效果较好。     

高度近视黄斑裂孔视网膜脱离的手术治疗

目的 探讨高度近视黄斑裂孔视网膜脱离手术的方法，并分析有关因素。方法 对18例高度近视眼黄斑裂孔视网膜脱离患者行玻璃体切割光凝联合眼内填充18％C3F8或硅油手术。结果 17例黄斑裂孔闭合，视网膜复位，1例因玻璃体积血患者放弃治疗。视力提高14例，视力不变2例，视力下降2例。并发症：玻璃体积血1例（未治），视网膜出血1例，眼压升高2例。结论 玻璃体切割、光凝联合眼内填充18％C3F8或硅油是治疗高度近视黄斑裂孔视网膜脱离安全有效的方法。     

不同手术方法治疗老年性特发性黄斑裂孔的疗效观察

目的 观察单纯玻璃体切割、玻璃体切割联合血小板封孔、玻璃体切割联合黄斑区内界膜剥除、玻璃体切割联合血小板封孔及黄斑区内界膜剥除4种手术方法治疗老年性特发性黄斑裂孔的疗效。 方法 回顾分析Ⅱ～Ⅳ期老年性特发性黄斑裂孔患者86只患眼的手术疗效。以上述4种手术方式分组的患眼数分别为7、40、14、25只眼，手术后随诊3～55个月，以手术后裂孔闭合、视力改变及手术并发症等作为疗效观察的指标。裂孔闭合判定标准为在检眼镜和(或)光相干断层成像术(optic coherence tomography,OCT)检查时不能分辨黄斑裂孔缘。远、近视力提高2行以上者计为视力改善。 结果 玻璃体切割联合血小板封孔组视力改善者占80.0%，优于其它3种治疗方法(P＜0.05)；单纯玻璃体切割组裂孔闭合率最低，占42.9%，与玻璃体切割联合血小板封孔组的裂孔闭合率(87.5%)、玻璃体切割联合血小板封孔及黄斑区内界膜剥除组的裂孔闭合率(92.0%)比较差异有显著性意义(P＜0.05)；视物变形改善、手术并发症等情况4组比较差异无显著性意义。 结论 玻璃体切割联合血小板封孔有助于老年性特发性黄斑裂孔患者手术后黄斑裂孔闭合及视力恢复；手术中使用黄斑区内界膜剥除技术可提高黄斑裂孔的解剖复位率，但视力预后不如玻璃体切割联合血小板封孔组。 (中华眼底病杂志, 2002, 18: 196-198)     

25-Gauge transconjunctival sutureless pars plana vitrectomy

PURPOSE: To evaluate the effectiveness, feasibility, and safety of the transconjunctival sutureless vitrectomy (TSV) system for a vriety of vitreoretinal diseases. METHODS: In this retrospective study, the authors evaluated 71 eyes of 63 patients who underwent pars plana vitrectomy (PPV) with the 25-gauge TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (29 eyes), diabetic macular edema (14 eyes), macular epiretinal membrane (13 eyes), endophthalmitis (5 eyes), vitreous opacities secondary to Behcet's disease (4 eyes), vitreous hemorrhage secondary to branch retinal vein occlusion (4 eyes), and vitreous hemorrhage secondary to age-related macular degeneration (2 eyes). Epiretinal membrane and internal limiting membrane removal, endolaser photocoagulation, and air-fluid exchange were performed when required. RESULTS: Mean follow-up was 3.6 months (range 1-8 months). Mean overall visual acuity (VA) was counting fingers (range light perception to 0.4) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p=0.000). Statistically significant VA improvement was observed in eyes with vitreous hemorrhage, diabetic macular edema, and macular epiretinal membrane. VA improved postoperatively in all eyes with endophthalmitis and vitreous opacities secondary to Behcet's disease. The surgery was completed without conjunctival and scleral suturing in all eyes. Mean intraocular pressure (IOP) was 17.2 mmHg (range 10-26 mmHg) preoperatively, 12.4 mmHg (range 6-24 mmHg) on the first postoperative day, 16.6 mmHg (range 10-33 mmHg) at 1 week, and 15.4 mmHg (range 10-20 mmHg) at 1 month postoperatively. On the first postoperative day, IOP was below 10 mmHg (between 6 and 9 mmHg) in 12 eyes (16.9%). In these eyes, IOP was normalized within 1 week without affecting the visual outcome. Five eyes (7%) had transient increase of IOP controlled by topical antiglaucomatous medications. Vitreous washout using 25-gauge TSV system was performed in two eyes, in which vitreous hemorrhage recurred. CONCLUSIONS: The TSV system was observed to be feasible, effective, and safe for a variety of vitre o retinal diseases. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time, and postoperative inflammatory response, and improve patient comfort.     

The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy

PURPOSE: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases. METHODS: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated. RESULTS: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months) CONCLUSIONS: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.     

25-gauge macular surgery: results and complications

PURPOSE: To report the safety and surgical outcome of 25-gauge transconjunctival sutureless vitrectomy for macular conditions. METHODS: In a single-center, retrospective, noncomparative case series, 160 eyes of 150 patients underwent 25-gauge vitrectomy for different macular conditions: 108 eyes for idiopathic macular pucker, 24 for idiopathic macular hole, and 28 for tractional diabetic macular edema. Main outcome measures were surgical time, preoperative and 1-day intraocular pressure (IOP), preoperative and 1-month, 3-month, and 6-month visual acuity, intraoperative and postoperative complications, anatomical results, and cataract progression. All patients were observed up for at least 6 months. RESULTS: Mean follow-up was 10 months (range, 6-20 months). Mean operative time +/- SD was 21 +/- 11 minutes. Mean 1-day IOP was 14 +/- 4 mmHg. No IOP was <8 mmHg on postoperative day 1. Mean overall preoperative visual acuity was 20/70, and mean overall postoperative visual acuity was 20/40 (P or=2 Snellen lines of visual acuity at 1 month; 74%, at 3 months; and 67%, at 6 months (P 相似文献   

Long-term observation of fundus infrared fluorescence after indocyanine green-assisted vitrectomy

PURPOSE: To observe the persistence of infrared fluorescence after indocyanine green (ICG)-assisted vitrectomy. METHODS: Eighteen consecutive patients underwent ICG-assisted vitrectomy for eyes with macular holes, epiretinal membranes, diabetic macular edema, and macular edema due to retinal vein occlusion. The internal limiting membrane was peeled after staining with 0.42% ICG solution. Postoperative observation of fundus infrared fluorescence was carried out using Heidelberg Retina Angiography (Heidelberg, Germany). RESULTS: Within a few months after surgery, intense fluorescence was observed around the macular hole and on the optic disk, photocoagulation scars, and the optic nerve fiber and was especially strong in the area along the vascular arcade. At the final visit (16-36 months after surgery), 12 (67%) of 18 eyes had infrared fluorescence that included fluorescence corresponding to the macular hole, retinal edema, and photocoagulation scars. The fluorescence over chorioretinal atrophy in a highly myopic eye disappeared compared with the area having an intact retinal pigment epithelium. CONCLUSIONS: Infrared fluorescence from ICG persists for 16 months to 36 months after ICG-assisted vitrectomy. ICG introduced directly into the vitreous cavity may remain in the eye over years. Careful long-term observation for the adverse effects of ICG is needed.     

Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy

PURPOSE: To report longer-term outcomes in eyes undergoing 25-gauge transconjunctival sutureless vitrectomy. DESIGN: Retrospective, noncomparative, case series. METHODS: Chart review of the initial 45 consecutive patients (45 eyes) that underwent TSV by one surgeon (T.S.H.) for idiopathic epiretinal membrane (n = 15), refractory diabetic macular edema (n = 11), idiopathic macular hole (n = 10), and nonclearing vitreous hemorrhage (n = 9). All patients had at least 6-month follow-up. Main outcome measures included visual acuity (VA), intraocular pressure, intraoperative complications, and postoperative complications. RESULTS: Mean follow-up was 13 months (range 6 to 25 months). Mean overall preoperative VA vs last postoperative VA was 20/229 and 20/65, respectively (P < .0001). Statistically significant VA improvement was seen for each patient subgroup. Mean preoperative intraocular pressure was 16.9 mm Hg (range 10-26 mm Hg). On postoperative day 1, week 1, and week 4, median intraocular pressure was 14.6 mm Hg (range 8-17 mm Hg), 17.6 mm Hg (range 8-38 mm Hg), and 17.7 mm Hg (range 9-33 mm Hg), respectively. No intraoperative complications occurred. Postoperative complications were 1 inferior retinal detachment (2.2%) 4 weeks after macular hole repair, 1 macular hole (2.2%) 6 months after epiretinal membrane peel, and 23 worsening cataracts in 29 phakic eyes (79.3%). CONCLUSIONS: Less surgically complex vitreoretinal pathology may be successfully repaired with TSV. After a mean follow-up of more than 1 year, minimal complications were seen, and none was specifically related to the sutureless nature of the procedure.     

23G玻璃体切割联合双重多次染色黄斑前膜、内界膜治疗黄斑裂孔性视网膜脱离

目的　研究２３Ｇ玻璃体切割联合双重多次染色黄斑前膜、内界膜治疗黄斑裂孔性视网膜脱离的疗效。方法　回顾性分析我院确诊的伴黄斑前膜的黄斑裂孔性视网膜脱离患者１９例１９眼。接受三通道闭合式经睫状体平坦部２３Ｇ玻璃体手术。手术在曲安奈德标记、亮蓝染色辅助下２３Ｇ玻璃体切割,２３Ｇ内界膜镊分层剥离黄斑前膜及内界膜,硅油填充。３个月后取出硅油填充Ｃ３Ｆ８气体。观察手术时间及术后最佳矫正视力、黄斑裂孔闭合和视网膜脱离复位情况,同时观察术中、术后并发症情况。术后随访６～１０（６．０±０．２）个月。结果　手术时间６０～９０ｍｉｎ,平均８０ｍｉｎ;黄斑裂孔封闭、视网膜复位率为９４．７％;术后最佳矫正视力０．０１～０．０４者３眼,０．０５～０．１０者１２眼,０．１２～０．２５者４眼;术中剥离内界膜时部分视网膜点状出血,用笛针吸除大部分出血,必要时行视网膜激光光凝。术后２眼高眼压,予以局部降眼压药物治疗,７～１３ｄ眼压平稳恢复正常。余未见其他术中、术后并发症发生。结论　２３Ｇ玻璃体切割联合双重多次染色黄斑前膜、内界膜治疗黄斑裂孔性视网膜脱离取得了较好疗效,不同程度上改善了视力,缩短了手术时间,减少了并发症的发生。     

Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases

Background A 25-gauge transconjunctival sutureless vitrectomy (TSV) has been reported effective. However, complications such as postoperative retinal detachment have been reported. In this study, we report four cases of retinal breaks found after 25-gauge TSV. In this study, we investigated factors contributing to occurrence of postoperative complications.Methods Seventy-five patients (75 eyes) underwent 25-gauge TSV surgery at Kanazawa University hospital between April 2004 and September 2005. Postoperative follow-up monitoring was done for at least 3 months. The surgical charts were reviewed.Results Retinal breaks not accompanied by retinal detachment were noted postoperatively in four patients. All four of these patients had preoperative idiopathic macular holes. In all cases, there was no vitreous traction around the retinal break and photo coagulation was performed. One eye with age-related macular degeneration developed intraoperative rhegmatogenous retinal detachment. No other complications were observed during the intraoperative and postoperative periods.Conclusion Upon performing 25-gauge TSV for macular hole repair, care should be taken to detect retinal breaks and retinal detachment intraoperatively and postoperatively.