Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy

Purpose  

To compare endophthalmitis rates after 20-gauge versus 23-gauge versus 25-gauge pars plana vitrectomy (PPV) in 2007–2008, and compare the rates with those of 2005–2006.     

20G联合23G玻璃体切除术在外伤性晶状体完全后脱位中的应用

目的探讨20G联合23G玻璃体切除技术在外伤性晶状体完全后脱位中的应用及临床疗效。方法回顾分析2013年1月-2013年12月行20G联合23G玻璃体切除术治疗外伤性晶状体完全后脱位共23例的临床资料,观察手术效果及并发症发生的情况。结果 21例（21眼）完成玻璃体联合晶状体切除。术后至随访期结束：86.96%的病例矫正视力有不同程度的提高;术前存在继发性青光眼者术后眼压均控制在正常范围;术后未出现持续性低眼压、感染性眼内炎等严重并发症。结论 20G联合23G玻璃体切除技术是治疗外伤性晶状体完全后脱位的安全、有效方法。     

Comparative outcomes of pars plana vitrectomy in acute postoperative endophthalmitis with 25-gauge and 20-gauge techniques

Purpose  

To evaluate the safety and outcomes of 25-gauge pars plana vitrectomy (PPV) in the treatment of postoperative endophthalmitis and compare it with 20-gauge PPV.     

23G微创与20G传统玻璃体手术的短期临床对比研究

目的比较23 G经结膜无缝线玻璃体手术与传统20 G玻璃体手术后短期内(1周)眼压、视力、手术时间及术后并发症。设计回顾性比较性病例系列。研究对象随机选择北京同仁医院2010年1月至2011年3月间行23 G玻璃体手术的15例(15眼)玻璃体积血患者及同期行20 G玻璃体手术18例(18眼)玻璃体积血患者。方法回顾上述患者住院病历资料,将其分为23 G微创和20 G传统玻璃体手术两组,分析两组患者术前及术后第1、3、7天眼压、视力以及手术时间、术后是否发生低眼压、眼内炎等并发症。主要指标眼压及视力,手术时间。结果术后33眼(100%)视网膜均复位。23 G组术后1周内眼压均低于20 G组,前者术后三个时间点眼压由低逐渐增加,分别为(10.87±3.48)、(11.53±4.84)、(11.80±5.68)mm Hg,后者术后三个时间点眼压由高逐渐降低,分别为(19.56±7.71)、(15.33±5.21)、(14.72±3.56)mm Hg,两组术后第1天眼压差异有统计学意义(t=4.0281,P=0.000);23 G组术后1周内平均对数视力logMAR逐步提高,三个时间点分别为2.11±1.00、1.93±1.02、1.64±1.00,术后第3、7天视力与术前相比有统计学意义(t=2.3578,P=0.033t;=3.5552,P=0.003),20 G组术后1周内平均对数视力也逐步提高,三个时间点分别为1.78±0.94、1.51±0.881、.48±0.91,术后三个时间点视力与术前相比差异均有统计学意义(t=3.3917,P=0.003t;=11.1779,P=0.000t;=4.3424,P=0.000),两组术后1周内三个时间点视力差异无统计学意义(t=0.9582,P=0.345t;=1.2761,P=0.211;t=0.4897,P=0.628);23 G组平均手术时间(37.20±7.47)分,少于20 G组平均手术时间(49.28±8.11)分,两者比较差异有统计学意义(t=4.4152,P=0.000);23 G组术后低眼压2例(13.33%),20 G组术后低眼压1例(5.56%),两组低眼压差异有统计学意义(χ2=8.6429,P=0.003)。两组均未发生眼内炎和视网膜脱离。结论 23 G微创玻璃体切除术比传统20G玻璃体切除术明显减少了手术时间且降低了术后眼压上升的风险,术后视力恢复无差异,是一种较安全有效的玻璃体手术方式,但术后早期低眼压发生率较高是该术式的主要并发症。     

Acute endophthalmitis following 23-gauge sutureless transconjunctival vitrectomy

We report a case that developed acute postoperative endophthalmitis after transconjunctival sutureless vitrectomy using the 23-gauge system. A 66-year-old man underwent non-sutured 23-gauge pars plana vitrectomy for epimacular membrane. Since the patient developed signs of acute endophthalmitis and decreased visual acuity to counting fingers on the second postoperative day, re-vitrectomy with silicone oil was performed. The patient responded well to re-vitrectomy, injection of silicone oil and intravitreal antibiotic injections. Methicillin resistant Staphylococcus epidermidis was cultured from vitreous samples. Silicone oil was extracted at 11 months. The patient remains stable at 14 months with a final visual acuity of 20/50.     

双通道27G玻璃体切除术治疗硅油填充眼复发性视网膜脱离

目的:研究双通道27G玻璃体切除术在硅油填充状态下治疗复发性视网膜脱离的可行性及优缺点.方法:回顾性研究.7例硅油填充眼在随访时发现下方视网膜浅脱离.在硅油填充状态下行双通道27G玻璃体切除术.术中完成视网膜表面增殖膜剥离、视网膜下液抽吸,并在视网膜复位后行硅油下视网膜激光光凝术,根据患眼病情辅以巩膜外垫压或环扎.结果:术后所有患眼视网膜均成功复位,术中未发生严重并发症.所有患眼术后眼表反应轻且视力迅速恢复至术前水平.1眼在术后20d出现视网膜再脱离,经传统的硅油取出联合视网膜复位术成功复位视网膜.结论:双通道27G玻璃体切除术是一个治疗硅油填充眼早期视网膜再脱离的有效方法,可能具有更高的性价比.     

Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes

PURPOSE: To compare the rates of endophthalmitis after 20-gauge versus 25-gauge pars plana vitrectomy (PPV) and to investigate clinical features of, and visual acuity outcomes, for patients with endophthalmitis after PPV. METHODS: A computerized database search was performed at each author's institution to identify all patients who underwent PPV by any of the authors between January 1, 2005, and December 31, 2006, and were subsequently treated for endophthalmitis. In addition, all patients who underwent PPV and were subsequently treated for endophthalmitis at Pennsylvania State College of Medicine (Hershey, PA) and Bascom Palmer Eye Institute (Miami, FL) during the study period were included. The medical records of these patients were reviewed to confirm that the endophthalmitis was associated with PPV and to collect clinical data to meet the study objectives. RESULTS: The incidence of endophthalmitis during the study period was 2 cases per 6,375 patients (or 1 case per 3,188 patients; 0.03%) for 20-gauge PPV compared with 11 cases per 1,307 patients (or 1 case per 119 patients; 0.84%) for 25-gauge PPV (P < 0.0001). Of 11 eyes that developed endophthalmitis after 25-gauge PPV, 9 received endophthalmitis prophylaxis with subconjunctival cefazolin after surgery. Median intraocular pressure on postoperative day 1 was 13 mmHg (range, 5-27 mmHg). Median time between PPV and endophthalmitis presentation was 3 days (range, 1-15 days). Presenting vision was hand motions or better in all eyes. Initial treatment included vitreous tap and injection of antibiotics in nine eyes and PPV and injection of antibiotics in two. All patients received intraocular treatment with vancomycin, and 10 received ceftazidime treatment. Eight patients had final visual acuity of >/=20/400, and four had visual acuity of >/=20/63. Cultures were negative in three cases; no culture specimens were obtained in one case. Six of the seven isolates were coagulase-negative staphylococci, and one was enterococcus. Five of six isolates tested for sensitivity to vancomycin were sensitive, and both isolates tested for sensitivity to ceftazidime were sensitive. CONCLUSIONS: The rate of endophthalmitis after 25-gauge PPV was significantly higher than that after 20-gauge PPV. Endophthalmitis after 25-gauge PPV occurred within 15 days of PPV, was usually due to coagulase-negative staphylococci sensitive to vancomycin, and was associated with variable visual outcomes.     

23G玻切头代替眼内膜剪用于20G玻璃体切割术治疗晚期PDR

目的：探讨在晚期增生性糖尿病视网膜病变（advanced proliferative diabetic retinopathy,PDR）20G玻璃体切割术中是否可应用23G玻璃体切割头代替眼内膜剪。方法：前瞻性非对照病例研究。对27例27眼经眼底检查和B超确诊为糖尿病视网膜病变Ⅵ期患者施行20G玻璃体切割术,术中以23G玻璃体切割头代替眼内膜剪清除新生血管膜,术毕完成全视网膜光凝,17眼灌注液填充,6眼填充12% C3F8,4眼填充硅油。随访3mo。分析患者玻璃体手术起止时间、术中发生的医源性裂孔数、手术中视网膜出血需电凝的次数,最佳矫正视力（BCVA）、视网膜复位情况。结果：手术时间为35～120（平均79.19±29.82）min; 术中发生医源性裂孔共2例（7%）。术后随访3mo,BCVA〉0.1者9眼,0.05～0.1者10眼,〈0.05者8眼。视网膜在位25眼（93%）,2眼术后硅油下视网膜仍未完全复位。结论：在20G玻璃体切割术治疗晚期PDR时,完全可以用23G玻璃体切割头代替眼内膜剪清除新生血管膜。     

Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy

Background

To study the surgically induced astigmatism (SIA) in combined phacoemulsification with 23-gauge transconjunctival sutureless vitrectomy (TSV) versus combined phacoemulsification with 20-gauge standard vitrectomy.

Methods

This is a prospective comparative study comprised of 40 eyes from 37 consecutive patients. Twenty eyes (19 patients) underwent combined phacoemulsification and 23-gauge TSV, and 20 eyes (18 patients) underwent combined phacoemulsification and 20-gauge standard vitrectomy. Corneal topography was obtained preoperatively and postoperatively at weeks 1, 4, 8, and 12. Main outcome measurement was SIA consisting of astigmatic amplitude and axis from cross cylinder form calculated by rectangular coordinate method using the Holladay-Cravy-Koch formula.

Results

The mean SIA was 1.07?±?0.57 diopters (D) in the 23-gauge TSV group and 2.09?±?0.81 D in the 20-gauge group at postoperative week 1. SIA of both groups at weeks 4, 8, and 12 significantly decreased from the SIA at postoperative week 1 (p?<?0.0001 for all 3 weeks). SIA of the 23-gauge TSV group was significantly less than that of the 20-gauge standard vitrectomy group at each postoperative period (p?=?0.001). SIA of the gas tamponade group in the 23-gauge TSV was significantly greater than that of the non-gas tamponade group at postoperative week one (p?=?0.039). Shifts of axis to other meridians returned to preoperative meridian in 12 eyes (85.7%) for the 23-gauge group and seven eyes (43.8%) for the 20-gauge group.

Conclusion

Combined phacoemulsification and pars plana vitrectomy (23-gauge and 20-gauge) could induce significant SIA at postoperative week 1, and decrease over 3 months. However, 23-gauge TSV showed less SIA and early stabilization compared to the 20-gauge standard vitrectomy.     

23 G灌注套管发生脉络膜下灌注的原因及防治

目的 探讨应用23 G灌注套管发生脉络膜下灌注的原因及防治方法.方法 对23 G玻璃体切除手术中发生灌注套管脉络膜下灌注24例进行回顾性分析.结果 24例（24眼）中,发生于原有睫状体或脉络膜脱离16例（66.7％）,前段增生性玻璃体视网膜病变（PVR）3例（12.5％）,灌注连接管固定过紧2例（8.3％）,外顶压下切除周边玻璃体3例（12.5％）.结论 应用23 G灌注套管发生脉络膜下灌注与脉络膜睫状体脱离、前段PVR及手术操作不当有关.术前充分评估、术中操作精细和及时发现并重新灌注对防治此误灌至关重要.