Passive removal of silicone oil with a 25-gauge sutureless system

Purpose To report the outcome of a new sutureless technique for passive removal of silicone oil with a 25-gauge system. Methods Between January 2005 and February 2006, 32 patients (32 eyes) underwent passive silicone oil removal with a 25-gauge system in a prospective, interventional case series in our hospital. Main data recorded were visual acuity, intraocular pressure (IOP), silicone oil removal time, complications, and number of sutured sites. Results Mean follow-up was 11.46 ± 3.98 months. Mean silicone oil removal time was 8.93 ± 0.85 (range, 7.0–11.5) min. A suture was placed in only one eye because of leakage. Visual acuity improved in 27 eyes (86.4%), and stabilized in five eyes (15.6%). IOP decreased significantly at all visits during follow-up. On day one, four eyes (12.5%) were hypotonous. Choroidal folds were observed in two eyes (6.25%). No other complications were noted. Conclusions Passive removal of silicone oil with a 25-gauge sutureless technique was effective for 1000 centistokes of oil. Transient hypotony in the early postoperative period did not adversely affect the visual outcomes. Presented as a paper at the Cannes Retina Festival, 24th Annual ASRS and 6th Annual EVRS Meeting, 12 September 2006     

Passive silicone oil removal in 23-gauge transconjunctival vitrectomy

The authors introduce a feasible technique of passive silicone oil removal via the pars plana using 23-gauge transconjunctival vitrectomy microsurgery instruments. The procedure consists of three-port transconjunctival insertion of 23-gauge microcannulas. An inferotemporal cannula is connected to an infusion line and the height of the bottle is raised. The other two open ports are used to remove intravitreal silicone oil with an externally applied cotton swab. Passive silicone oil removal was conducted using the 23-gauge system in 46 phakic or pseudophakic eyes with silicone oil of both 1,000 (n = 39) and 5,000 centistokes (n = 7). A suture was placed for one of three sclera entry sites in 17 eyes. Cataract extraction with phacoemulsification was combined with passive silicone oil removal in 14 eyes. Transient hypotony was observed in 2 eyes. No retinal redetachment or other procedure-related complications were encountered.     

Keratometric alterations following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy

Purpose: To assess the alterations in keratometric astigmatism following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Methods: Sixteen consecutive patients were enrolled into the study. Conventional vitrectomy was applied to eight of the cases and 25‐gauge transconjunctival sutureless vitrectomy was performed in eight patients. Keratometry was performed before and after the surgery. Results: In the 25‐gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were not observed in the corneal curvature in any post‐operative follow‐up measurement (p > 0.05); whereas in the conventional pars plana vitrectomy group, statistically significant changes were observed in the first postoperative day (p = 0.01) and first postoperative month (p = 0.03). We noted that these changes returned to baseline in three months (p = 0.26). Conclusion: Both 25‐gauge transconjunctival sutureless and conventional pars plana vitrectomy are effective surgical modalities for selected diseases of the posterior segment. Surgical procedures are critical for the visual rehabilitation of the patients. The post‐operative corneal astigmatism of the vitrectomised eyes can be accurately determined at least two months post‐operatively     

Efficacy and safety of active silicone oil removal through a 23-gauge transconjunctival cannula using an external vacuum pump

AIM: To evaluate the efficacy and safety of active removal of silicone oil with low and high viscosity through a 23-gauge transconjunctival cannula using an external vacuum pump. METHODS: This study was conducted as a prospective, interventional case series. A total of 22 eyes of 21 patients [1000 centistokes (cSt): 17 eyes, 5700 cSt: 5 eyes] were included in this study. All patients underwent active silicone oil removal via the entire lumen of a 23-gauge microcannula with suction pressure of a 650-700 mm Hg vacuum using an external vacuum pump. A tubing adaptor from the Total Plus Pak® (Alcon, Fort Worth, USA) was used to join the microcannula and silicone vacuum tube connected to an external vacuum pump. Main outcome measures were mean removal time, changes of intraocular pressure (IOP) and visual acuity, and intraoperative and postoperative complications. RESULTS: Mean removal time (min) was 1.49±0.43 for 1000 cSt and 7.12±1.27 for 5700 cSt. The IOP was 18.57±7.48 mm Hg at baseline, 11.68±4.55 mm Hg at day 1 postoperatively (P<0.001), and 15.95±4.92, 16.82±3.81, 17.41±3.50, and 17.09±3.01 mm Hg after one week, one month, three months, and six months, respectively. All patients showed improved or stabilized visual acuity. There was no occurrence of intraoperative or postoperative complications during the follow up period. CONCLUSION: This technique for active removal of silicone oil through a 23-gauge cannula using an external vacuum pump is fast, effective, and safe as well as economical for silicone oil with both low and high viscosity in all eyes with pseudophakia, aphakia, or phakia.     

Silicone oil tamponade in 23-gauge transconjunctival sutureless vitrectomy

PURPOSE: To describe 20 consecutive patients treated with 23-gauge transconjunctival sutureless vitrectomy and silicone oil tamponade for retinal detachments (RD) of different etiologies. METHODS: Prospective case series. Twenty patients with complex retinal detachment were submitted to a primary 23-gauge transconjunctival pars plana vitrectomy: rhegmatogenous retinal detachment with proliferative vitreoretinopathy (RRD + PVR) in 7 cases, diabetic tractional retinal detachment (DTRD) in 5 cases, giant retinal tear (GRT) in 2 cases, RRD with multiple tears in 2 cases, GRT + uveitis in 1 case, RRD + uveitis in 1 case, DTRD + RRD in 1 case, and RRD + PVR with intraocular foreign body (IOFB) in 1 case. Length of postoperative follow up ranged from 3 to 14 months. RESULTS: Final visual acuity ranged from 20/25 to hand motion. Postoperatively, none of the 20 eyes had hypotony or leakage of silicone oil through the sclerotomies. Seventeen out of 20 (85%) had improved vision. CONCLUSION: Silicone oil tamponade was demonstrated to be a feasible option in conjunction with 23-g transconjunctival sutureless vitrectomy to treat complex retinal detachment.     

Timing of retinal redetachment after removal of intraocular silicone oil tamponade

PURPOSE: To evaluate the interval between removal of intraocular silicone oil tamponade and retinal redetachment after pars plana vitrectomy, and to investigate factors influencing the length of the interval. PATIENTS AND METHODS: The retrospective study included 42 eyes of 42 consecutive patients who experienced a retinal redetachment after silicone oil had been removed 8.0+/-6.2 months after an initial pars plana vitrectomy including intraocular silicone oil (5,000 centistokes) tamponade. Pars plana vitrectomy had been performed for proliferative vitreoretinopathy caused by complicated rhegmatogenous retinal detachment. RESULTS: The retina redetached 2 days to 5.5 months after silicone oil removal (mean +/- SD, 1.3+/-1.4 months; median, 18 days). Thirteen (30%) of all 42 redetachments occurred in the first 9 days, 21 (50%) of all 42 retinal redetachments occurred in the first 18 days, and 32 (75%) of all 42 retinal redetachments occurred in the first 50 days. The interval between silicone oil removal and retinal redetachment was statistically (by analysis of variance) independent of the method of silicone removal (transpupillary drainage vs via pars plana sclerotomies), refractive error of the eye (P = .62), time between initial pars plana vitrectomy and silicone oil removal (P = .99), visual acuity before silicone oil removal (P = .26), type of anesthesia (P = .69), gender (P = .80), and age (P = .48) of the patients. CONCLUSION: The risk of retinal redetachment decreases steeply with increasing time after silicone oil removal. Three to 5 months after oil removal, retinal redetachment becomes unlikely. The time of retinal redetachment is statistically independent of the method of silicone oil removal, refractive error, time between the preceding pars plana vitrectomy and silicone oil removal, visual acuity before silicone oil removal, type of anesthesia, and gender and age of the patents. These data may be important for scheduling reexaminations and for counseling patients in their planned activities after removal of intraocular silicone oil tamponade.     

Comparison of 25-gauge sutureless vitrectomy and 20-gauge vitrectomy in the treatment of posterior capsule opacification in pseudophakic children

AIM: To compare the effectiveness and safety of pars plana capsulotomy and vitrectomy using 25-gauge tansconjunctival sutureless vitrectomy system and 20-gauge vitrectomy system for posterior capsule opacification (PCO) in pseudophakic children. METHODS: Retrospectively study. Pars plana capsulotomy and vitrectomy using 25-gauge sutureless vitrectomy system was performed for PCO in the study group (32 eyes). Patients in the control group (34 eyes) underwent capsulotomy and vitrectomy using standard 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. The two groups were performed consequentially. The patients ages ranged from 2 to 13y (means: 6.61±2.73y). Surgical technique, intraoperative and postoperative complications, visual acuity, IOP, and recurrent PCO were recorded. RESULTS: The surgical procedure was performed uneventfully in all patients. Visual acuity improved significantly in both groups. BCVA improved in 22 eyes (81.5%) in the study group and in 28 eyes (87.5%) in the control group. There was no statistical difference of visual acuity that were attainable in two groups (H=0.115, P=0.909). Mean postoperative IOP showed no significant difference between the groups at 1wk. All sort of PCO were accomplished by 20-gauge system, while 25-gauge system was effective for pearls style and 2 grade of fibrous PCO, and was insufficient to grade 3 of PCO. In the study group two cases were not accomplished by 25-gauge system while 20-gauge system conquered them. Compared with the control group, mean operative time for opening and closing the sclerotomy in the study group was considerably reduced. The mean follow-up was 38.2mo (range: 8-79mo). During the follow-up period, no incision leakage, corneal edema, vitreous loss, IOL damage, retinal detachment, recurrent PCO, or other complications were noted. CONCLUSION: Pars plana capsulotomy and vitrectomy using 25-gauge transconjunctival sutureless vitrectomy appeared to be a safe and effective approach for PCO in pseudophakic children. Combined sutureless surgery needed shorter setup time for sclerotomy and caused less surgical trauma than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with PCO in pseudophakic children.     

Surgical management of secondary glaucoma after pars plana vitrectomy and silicone oil injection for complex retinal detachment

OBJECTIVE: To evaluate the outcomes of surgical intervention for secondary glaucoma after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Forty-three eyes of 43 patients who underwent incisional surgery for secondary glaucoma after pars plana vitrectomy and silicone oil injection for repair of complex retinal detachment over a 9-year period. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), intraoperative and postoperative complications, visual acuity, and the need for further surgical intervention for glaucoma. Success was defined as IOP < or =21 mmHg and > or =5 mmHg with or without medication but without surgical reoperation for glaucoma. RESULTS: Findings associated with elevated IOP included emulsified oil in the anterior chamber (n = 14), pupillary block from silicone oil (n = 13), open-angle glaucoma without silicone oil in the anterior chamber (n = 9), and angle-closure glaucoma without pupillary block (n = 7). The mean (+/- standard deviation) IOP was 41.4 +/- 15.1 mmHg before surgery for glaucoma and 17.2 +/- 10.2 mmHg after an average follow-up of 19.6 months (P < 0.001). Cumulative success was 69%, 60%, 56%, and 48% at 6, 12, 24, and 36-months respectively. In patients who underwent silicone oil removal alone for surgical management of glaucoma (n = 32), 11 of 12 IOP failures (92%) were due to uncontrolled IOP, whereas most IOP failures in the group who underwent silicone oil removal plus glaucoma surgery (n = 8) failed because of hypotony (3 of 4, 75%, P = 0.027). Of three patients who underwent glaucoma surgery alone to control IOP, one failed because of hypotony. There was no significant change in visual function at last follow-up (logarithm of the minimum angle of resolution [logMAR] 2.01) compared with preoperative visual function (logMAR 2.07, P = 0.74). CONCLUSION: Surgical management of secondary glaucoma after silicone oil injection for complex retinal detachment may achieve good IOP control and stabilization of visual function in most patients. Patients who undergo silicone oil removal alone to control IOP are more likely to have persistent elevation of IOP and possibly undergo reoperation for glaucoma, whereas patients who undergo concurrent silicone oil removal and glaucoma surgery are more likely to have hypotony.     

Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications.

BACKGROUND AND OBJECTIVE: The complications of 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications were reviewed. PATIENTS AND METHODS: Thirty-eight patients underwent 25-gauge transconjunctival sutureless vitrectomy. Indications for vitrectomy, preoperative and postoperative best-corrected visual acuity, preoperative and postoperative intraocular pressure, and any intraoperative or postoperative complications were recorded. RESULTS: Complications included the need to suture a leaking sclerotomy intraoperatively in four eyes (9%), all of which involved oil removal; postoperative hypotony with choroidals in two eyes (5%); mild progression of nuclear sclerotic cataract in one eye (2% of all eyes, 4% of phakic eyes); the need to switch to 20-gauge pars plana vitrectomy in one eye (2%); corneal abrasion in one eye (2%); and retinal detachment in one eye (2%). Sclerotomy leakage and hyopotony with choroidals were only encountered in cases involving previously vitrectomized eyes, whereas none of the eyes without previous vitrectomy had leakage-related complications. CONCLUSIONS: Previously vitrectomized eyes have a higher incidence of complications related to postoperative leakage, possibly due to the lack of plugging effect of peripheral vitreous on the unsutured sclerotomy. One should consider suturing any leaking sclerotomy at the conclusion of surgery involving previously vitrectomized eyes.     

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.     

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.     

硅油眼的硅油取出联合白内障超声乳化术的疗效观察

目的观察玻璃体切除术后硅油填充眼患者硅油取出联合超声乳化人工晶状体植入术的术后视力、屈光度变化和术中及术后并发症情况。方法收集17例(17眼)玻璃体切除术后硅油填充眼的白内障患者,行硅油取出联合超声乳化人工晶状体植入术,观察术前及术后最佳矫正视力(BCVA)、眼压,术中及术后并发症情况,并对术后实际屈光度和术前目标屈光度进行比较。结果随访时间为3～14.5个月,平均(4.00±2.81)个月。6眼术后BCVA为0.05～0.1,6眼为0.12～0.3,4眼为0.4～0.7,1眼>0.8。术后眼压为(13.61±3.67)mm Hg(1mm Hg=0.133kPa),与术前(16.31±6.95)mm Hg相比,差异无统计学意义(Z=1.1043,P=0.2933)。术后实际测得屈光度为(-1.09±3.91)D,与术前目标屈光度(-1.46±1.29)D相比,差异无统计学意义(Z=3.7504,P=0.0527)。术中1眼出现灌注偏离综合征,9眼行中央部后囊膜切除,所有患者术中未出现晶状体坠入玻璃体腔等并发症。术后早期5眼出现轻度角膜水肿,1眼行掺钕钇铝石榴石(Nd:YAG)激光后囊膜切开,2眼发生视网膜再次脱离。结论玻璃体切除硅油填充患者行硅油取出联合超声乳化人工晶状体植入术可有效提高视力,术后实际屈光度与术前目标屈光度较为一致,手术并发症少,手术方法安全、有效。     

Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia

PURPOSE: To evaluate phacoemulsification combined with transpupillary silicone oil removal and foldable intraocular lens (IOL) implantation through a single corneal incision and planned posterior capsulorhexis after pars plana vitrectomy using topical anesthesia. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: This noncomparative nonrandomized noncontrolled interventional case series comprised 34 consecutive patients (34 eyes). The mean age of the 25 men and 9 women was 54.4 years +/- 13.3 (SD). A mean of 8.2 +/- 9.4 months after silicone oil injection, patients had phacoemulsification with transpupillary silicone oil removal and foldable acrylic IOL implantation through a single corneal incision and a planned posterior capsulorhexis under topical anesthesia. Patients were operated on by the same surgeon. Visual acuity, the frequency of retinal redetachment, secondary cataract and vitreous hemorrhage formation, subjective pain and discomfort, the duration of surgery, and intraocular pressure (IOP) were noted. The mean follow-up was 9.4 +/- 5.1 months (range 4 to 21 months). RESULTS: Vision improved or stabilized in 88.2% of eyes. Retinal redetachment occurred in 4 eyes (11.8%) and transient vitreous hemorrhage in 1 (2.9%). All patients reported minimal discomfort during the procedure. The mean duration of surgery was 17 +/- 4 minutes. There was no significant intraoperative or postoperative IOP variation. CONCLUSIONS: Combined phacoemulsification, transpupillary silicone oil removal, and IOL implantation through a single corneal incision under topical anesthesia was safe and effective. In general, the visual outcomes were good with improvement in visual acuity.     

两种硅油取出术并发症分析

目的:比较常规扁平部三通道硅油取出术和既往两切口单纯硅油取出术的手术并发症,考察并评价其临床效果。方法:回顾性分析2001-04/2003-06以及2003-06/2006-11两个时期(分为两组)在本院行硅油取出术的临床连续病例。前组共78例(78眼),47例无晶状体眼采用角膜缘或角膜小切口取出硅油;7例有晶状体眼采用睫状体平坦部双切口取硅油;16例联合白内障手术者,常规行超声乳化或ECCE术,再撕开后囊膜,从前房白内障手术切口放出硅油;8例视网膜复位欠佳,或局部有增生膜者,硅油取出联合常规三通道玻璃体切除术。后组病例共113例(113眼),不论有无晶状体,全部病例均采用常规扁平部三通道取硅油,取油时联合切除残余玻璃体基底部、视网膜光凝及剥离视网膜前膜。硅油取出术后随访5mo～5a,平均随访时间为(2.7±2.1)a。结果:前组中共有3例发生脉络膜上腔出血(3.8%);15例发生视网膜再脱离(19.2%);8例眼压控制不良需加用降眼压药物(10.3%);12例出现低眼压(眼压<5mmHg)(15.4%);1例术后发生角膜内皮失代偿(1.3%);38眼视力提高2行以上(48.7%)。后组病例中未出现脉络膜上腔出血和新发角膜病变,11例发生视网膜再脱离(9.7%),与前组比较差异具有统计学意义(P<0.05)。7例眼压控制不良需加用降眼压药物(6.2%),15例出现低眼压(13.3%);58眼视力提高2行以上(51.3%)。结论:虽然两切口单纯硅油取出术方法简单,在几年前应用较为普遍,但术中不能做一些眼底的详细检查及适当处理;而常规扁平部三切口硅油取出可以联合玻璃体切割及膜剥离、激光光凝等操作,有助于保持视网膜复位和视功能提高,减少并发症的出现,具有广泛的临床应用价值。     

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.     

睫状体平坦部硅油取出术联合超声乳化白内障摘除术短期效果观察

目的:观察硅油填充眼的白内障超声乳化联合睫状体平坦部硅油取出手术的治疗效果。方法:对2005-01/2007-01我院收治的24例24眼玻璃体切除术后硅油填充眼患者,实施白内障超声乳化联合睫状体平坦部硅油取出术,观察术后视力、并发症等。结果:术中发生视网膜脱离3例3眼(12%)。术后3mo最佳矫正视力>0.3者1眼(4%);0.12～0.3者16眼(67%);≤0.1者7眼(29%);植入人工晶状体21眼(88%);未植入人工晶状体3眼(12%)。结论:硅油填充眼的白内障超声乳化联合睫状体平坦部硅油取出术是安全有效的手术方式。     

25G玻璃体切割术后空气与硅油填充治疗孔源性视网膜脱离的疗效比较

目的:比较25G玻璃体切割术(PPV)联合空气或硅油填充治疗孔源性视网膜脱离(RRD)的疗效。方法:前瞻性随机对照研究。收集2018-01/12经我院确诊的RRD患者146例146眼,根据25G PPV术后眼内填充物分为空气组(60例60眼)和硅油组(86例86眼)。术后随访6~12mo,分析两组患者最佳矫正视力(BCVA)、眼压、视网膜解剖复位率及并发症情况。结果:术后1mo,空气组患者BCVA为0.45±0.5,硅油组为0.78±0.65,两组患者BCVA均较术前明显改善,且空气组患者BCVA明显优于硅油组(均P<0.05)。术后3mo,空气组患者视网膜解剖复位率(93.3%)低于硅油组(97.7%),但无差异;术后6mo,两组患者视网膜解剖复位率均为100.0%。本研究纳入患者术中主要并发症是医源性裂孔(6.8%),术后主要并发症是高眼压,术后早期(7d内)硅油眼高眼压比例明显高于空气组(P<0.001),但随访期间两组患者均未出现感染性眼内炎、脉络膜出血等严重并发症。结论:对于简单新鲜的RRD患者,25G PPV术后空气和硅油填充视网膜解剖复位率无差别,术后早期空气填充眼视力优于硅油填充眼,术后高眼压发生率更低。     

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。     

Anatomic and Functional Outcome of Triamcinolone-assisted 23-gauge Vitrectomy in Vitreomacular Traction Syndrome

Purpose: To evaluate the outcomes of patients with vitreomacular traction syndrome (VMT) treated with triamcinolone acetonid (TA) assisted 23-gauge (23-G) transconjunctival sutureless vitrectomy.

Methods: Restrospective, case series. The medical charts of 13 eyes of 13 consecutive patients with VMT who underwent 23-gauge transconjunctival pars plana vitrectomy were reviewed. All patients had at least six-month follow-up. The main outcome parameters were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) between the baseline and postoperative follow- up examinations performed at the first, third, and sixth months after the surgery.

Results: The mean follow-up period was 7 (range 6–15) months. The mean preoperative BCVA was 1.3±0.4 (logmar). The final BCVA was 0.5±0.3 (logmar) (p = 0.001). The mean CMT was 429±85 µm at baseline, which was significantly reduced to 255±47 µm at the final follow-up visit (p = 0.001). The mean CMT reduction was 174±101 (range: 32–348) µm. No postoperative complications were seen such as endophthalmitis, retinal detachment, hypotony, or glaucoma.

Conclusion: Triamcinolone assisted 23-G transconjunctival sutureless vitrectomy is an effective and safe surgical technique in the management of VMT syndrome. Further studies with large case series are needed.     

微切口超声乳化术联合硅油取出术治疗玻切术后硅油填充眼合并白内障

目的：观察玻璃体切割术后硅油填充眼行微切口白内障超声乳化联合睫状体平坦部硅油取出术的临床疗效。 方法：2013-02/11对43例43眼玻璃体切割术后硅油填充眼合并白内障患者行微切口白内障超声乳化联合睫状体平坦部硅油取出术,术中均Ⅰ期植入人工晶状体,观察患者术后3 mo最佳矫正视力和手术并发症发生情况等。结果：术后3mo,最佳矫正视力较术前提高者共39例（91%）,最高矫正视力达0.6,视力无提高者4例（9%）。所有患者均未发生后囊膜破裂、硅油残留、角膜内皮失代偿、前房积血、玻璃体积血、人工晶状体移位、继发性青光眼、锯齿缘离断等并发症。 结论：微切口超声乳化人工晶状体植入术联合睫状体平坦部硅油取出术是一种有效、安全的手术方式。