A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula

AIM: To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana. METHODS: Forty-eight eyes of 48 patients underwent silicone oil (5700 centistokes) removal (SOR) were enrolled. A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine. Silicone oil was removed with suction of 500-mm Hg vacuum through the cannula. Main outcome measures were SOR duration, number of sutured sites, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications. RESULTS: Silicone oil was successfully removed in all cases. The mean SOR time was 5.70±0.85min. Nine eyes (18.75%) needed suture partial sclerotomies. No intraoperative complications were noted. Transient hypotony (≤8 mm Hg) was seen in 3 eyes (6.25%) on postoperative day 1, but all resolved within 1wk. Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up. BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level. CONCLUSION: Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.     

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     

23G玻璃体切割系统硅油取出30例临床观察

目的:评价23-Gauge (23G)玻璃体切割系统应用于硅油取出术的安全性和有效性。方法:回顾分析厦门眼科中心2011-02/06连续收治的硅油填充患者58例58眼。30例30眼应用23G玻璃体切割系统,28例28眼应用20G玻璃体切割系统行硅油取出术的临床资料。对两组平均手术时间、硅油取出时间,术前、术后1d;1wk;3,6mo的眼压、最佳矫正视力应用t检验进行比较分析。并对比两组网膜复位情况、并发症及患者舒适度。结果：23G组与20G组平均手术时间分别为21.81±564min及35.43±6.42min（t=6.382,P<0.01）;平均硅油取出时间分别为6.8±2.76min及6.4±2.41min（t=0.356,P>0.05）。术前、术后1d;1wk;3,6mo平均最佳矫正视力分别为：23G组：0.35±0.21,0.23±0.22,0.26±0.21,0.38±027,0.45±0.26;20G组：0.36±0.28,0.10±0.26,0.24±0.27,0.37±0.25,0.41±0.23。术前、术后1wk;3,6mo两组间平均最佳矫正视力差异无统计学意义（t值分别为0584,0.474,0.583,0.652,P均>0.05）;术后1d 23G组优于20G组（t=1.753,P<0.05）。术前、术后1d;1wk;3,6mo平均眼压分别为：23G组：18.3±2.21,12.2±2.42,15.2±231,16.3±2.97,16.5±2.23;20G组：17.6±2.28,11.1±2.47,16.4±2.37,16.9±2.27,17.4±2.26。术前、术后两组间平均眼压差异无统计学意义（P>0.05）;术后1d两组平均眼压均较术前降低,组内差异有统计学意义（t=1779,1.874,P<0.05）,余时间点组内差异无统计学意义（P>0.05）。20G组所有患者均一次性完整取出硅油,23G组2例残留少量硅油小泡,至末次随访时均自行吸收。术后两组视网膜均在位。并发症：术后1d 20G组出现2例（7%）低眼压患者,23G组出现4例（13%）,均在术后1wk后好转。两组均未出现眼内出血、脉络膜脱离、眼内炎等并发症。23G组与20G组术后眼痛等不适的平均周数分别为0.85±1.23,2.62±1.23wk（t=5.942,P<0.01）;术后眼红外观持续平均周数分别为1.15±1.23,4.13±2.38wk（t=5.753,P<0.01）。结论:23G经结膜无缝线玻璃体切割系统应用于硅油取出术安全有效。     

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。     

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。     

改良两切口23G经结膜免缝合玻璃体切割系统硅油取出术的观察

目的：：评价一次性输血器和自制抽吸头用于23 G经结膜免缝合玻璃体切割系统硅油取出术的有效性和安全性。方法：将23 G灌注管在距离末端5 mm处剪断,制成抽吸头,用于连接一次性输血器和23 G穿刺套管。将输血器的莫菲氏管及以上部分剪除,连接玻璃体切割器的积液盒,利用玻璃体切割器的吸引系统通过睫状体平坦部的两切口主动抽吸清除眼内硅油。结果：患者132例手术中仅有13例(9.8%)需要缝合穿刺口,手术时间为7~28(平均15.1±6.2)min。术后早期107例(81.1%)患者眼压低于11mmHg,并有2例出现周边脉络膜隆起,术后1 wk 眼压基本恢复正常,但有2例(1.5%)高度近视合并黄斑裂孔性视网膜脱离患者出现视网膜再脱离。大部分患者硅油清除干净,仅有4例(3.0%)有少许硅油残留。结论：利用一次性输血器和自制抽吸头连接玻璃体切割器的吸引系统行两切口23 G经结膜免缝合硅油取出术具有安全、有效、快捷、经济等优点,值得推广应用。     

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.     

Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy

Purpose

To compare the intraocular pressure (IOP) after 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various vitreoretinal diseases.

Methods

This was a retrospective interventional case series including 338 cases of 23-gauge TSV and 476 cases of 20-gauge vitrectomy with minimum follow-up period of 1 month. Postoperative 1 day, 1 week and 1 month IOPs were compared. Multiple regression analysis to assess the actual effect of gauge of vitrectomy on postoperative IOP was performed including intraoperative and postoperative factors influencing postoperative IOP as covariates.

Results

The mean IOP of 20-gauge vitrectomy was significantly higher than that of 23-gauge TSV (20.6±8.02 mm Hg vs12.8±4.48 mm Hg, P<0.001) at postoperative day 1, but the differences were not significant at postoperative 1 week and 1 month. The IOP pattern of 23-gauge TSV demonstrated more stable course than that of 20-gauge vitrectomy. At 1 day post vitrectomy, the incidence of hypertony was higher in 20-gauge, whereas that of hypotony was higher in 23-gauge. Among risk factors, the 20-gauge vitrectomy showed the strongest association with postoperative 1 day IOP rise.

Conclusion

Twenty-three-gauge TSV has stable and lower IOP in the early postoperative period than the 20-gauge vitrectomy. In patients whose retina and optic nerves are vulnerable to higher or fluctuating IOP, 23-gauge TSV may be more beneficial.     

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.     

Evaluation of limbal and pars plana silicone oil removal in aphakic eyes

Purpose: To compare limbal and pars plana silicone oil removal (SOR) in aphakic eyes and to evaluate the acute effect of silicone oil flow to the corneal endothelium. Methods: Sixteen aphakic patients with silicone oil endotamponade requiring SOR were recruited for this prospective study and randomly scheduled for limbal or pars plana SOR. The central corneal thickness (CCT), visual acuity (VA) and intraocular pressure were measured preoperatively, on the first postoperative day and 4 months after surgery. Endothelial cell density (ECD) was measured preoperatively and at the end of follow‐up. The in vitro study was performed on ten enucleated porcine eyes. Corneoscleral discs were prepared and fixed on artificial anterior chamber followed by 2.5‐mm limbal incision and 5‐ml silicone oil injection in six cases and 5 ml balanced salt solution (BSS) in four cases. Results: The ECD decreased by 239.2 ± 86.7 (13.9%) and 86.7 ± 22.4 cells/mm² (5%) after limbal (n = 8) and pars plana SOR (n = 8), respectively (p < 0.001 for both). The difference between the groups was significant (p < 0.001). A significant increase in CCT and corresponding decrease in VA was noted on the first postoperative day using both procedures. At the end of follow‐up, the CCT and VA were comparable to initial values. Postoperative hypotony (≤6 mmHg) was observed more frequently after limbal SOR. In the experiment, lamellar abrasions of corneal endothelium were observed after silicone oil injection, whereas no changes were observed after BSS injection. Conclusion: Limbal SOR causes more considerable damage to the corneal endothelium than the pars plana approach because of mechanical abrasion.     

改良微创23G联合20G三通道硅油取出的临床观察

目的：观察使用改良微创23G联合20G三通道硅油取出手术的疗效。

方法：回顾性研究,收集2018-03/2019-09在晶亮眼科医院住院的硅油眼患者32例32眼,行玻璃体切割常规三通道切口,做23G的灌注、照明及20G的10：00位抽吸切口,使用23G微创玻璃体切割仪联合改良的18G取硅油针头抽取硅油,检查手术后1d,1wk,1、3mo的BCVA、眼压、疼痛舒适度、硅油残留、脉络膜脱离、视网膜脱离等情况。

结果：所有32例患者手术顺利,手术过程中眼内压平稳,无波动。抽取硅油时间约10～15min,术中无并发症发生; 术后随访3mo,均未发现玻璃体积血、脉络膜脱离、视网膜再脱离。

结论：改良微创23G联合20G三通道硅油取出方法简单、安全、平稳、有效。     

睫状体平坦部硅油取出联合后囊膜切开术临床观察

目的 探讨睫状体平坦部硅油取出联合后囊膜切开术的临床效果.方法 对2008年1月至2010年1月间48例(48只眼)玻璃体切割联合硅油注入眼并发后发障患者行睫状体平坦部硅油取出联合后囊膜切开术.结果 术后矫正视力提高34只眼(70.8％).出现3例(6.3％)持续性低眼压、1例(2.1％)玻璃体腔少量血性混浊,所有病例均无大性角膜病变、硅油泡残留、人工晶状体移位或损伤、玻璃体积血等并发症.结论 经睫状体平坦部硅油取出术联合后囊膜切开术对玻璃体切除手术后硅油充填眼并发后发障是一种安全、便捷有效的手术方式.     

23G和20G玻璃体切割手术治疗IEM的对比研究

目的：比较 23G经结膜无缝线玻璃体手术与传统20G玻璃体手术治疗特发性黄斑前膜（IEM）的疗效。 方法：将2008-03/2011-06在我院诊断为黄斑前膜并需行玻璃体切割的连续病例56例56眼随机分为23G组与20G组,分别行23G及20G玻璃体切割手术。统计分析术后1d,1wk,3mo时最佳矫正视力、眼压、术中术后并发症、手术时间及术后前房炎症反应及眼部刺激征的严重程度,术后随访5～22（平均16）mo。 结果：23 G组术后3mo内平均对数视力log MAR逐步提高,三个时间点分别为1.78±0.94,1.51±0.88,1.48±091,术后第1d,1wk,3mo视力与术前相比有统计学意义(t=3.3917,P=0.003;t=11.1779,P=0.0000;t=4.3424,P=0.0000);20G组术后平均对数视力也逐步提高,三个时间点分别为2.11±1.00,1.93±1.02,1.64±1.00,术后第1wk,3mo视力与术前相比有统计学意义(t=2.3578,P=0.033;t= 3.5552,P=0.003)。两组术后3mo内三个时间点视力差异均无统计学意义(t=0.9582,P=0.34;t=12761,P=0.211;t=0.4897,P=0.628)。23G组术后3个时间点眼压分别为11.62±9.7,15.86±6.6,16.84±56mmHg,20G组术后3个时间点眼压分别为18.56±7.71,15.33±5.21,14.72±3.56mmHg,两组术后第1d眼压差异有统计学意义（P<0.001）。 23G组平均手术时间41.20±7.47分,少于20G组平均手术时间52.28±7.11分,两者比较差异有统计学意义（P<0.001）。两组术后无视网膜脱离、黄斑前膜复发及眼内炎的发生。23G组术后的炎症反应及刺激症状明显轻于20G组。 结论：23G TSV治疗IEM简化了手术步骤,增加了患者舒适度,提高了手术效率和质量,实现了玻璃体切割手术的微创化,值得应用。     

23G玻璃体切除系统用于硅油取出的研究

目的评价23G经结膜无缝合玻璃体切除系统应用于Oxane5700硅油取出术的效果。方法回顾性分析连续病例68例（68只眼）临床资料,分为23G微创组（35只眼）和20G传统组（33只跟）,两组进行比较。结果所有患眼均成功取出硅油,平均随访（5．61±1．24）个月。23G组和20G组手术时间差异有统计学意义（t=21．582,P=0．000）;术后1d23G组最佳矫正视力优于20G组,两组差异有统计学意义（F=5．308,P〈0．05）。术后1d两组平均眼压较术前均明显降低,两组差异有统计学意义（F=6．087,P〈0．05）。术后及随访期间,两组术后眼疼痛不适及结膜充血眼红外观差异有统计学意义（Z=-2．253,-3．628,P〈0．05）。结论23G与20G玻璃体切除系统行Oxane5700硅油取出术比较,前者手术操作时间短、术后眼部疼痛轻、眼红外观持续时间短及患者舒适度高,且术后并发症的发生率无明显差异,是种快速安全有效的微创手术方式。     

23G与20G玻璃体切割治疗增殖性糖尿病视网膜病变玻璃体出血对比研究

目的 对比23G与20G玻璃体切割技术治疗增殖性糖尿病视网膜病变引起的玻璃体出血临床疗效.方法 临床病例对照研究.收集2010年3月至2012年9月在宣武医院眼科诊治的增殖性糖尿病视网膜病变,所致玻璃体出血需行玻璃体切割手术治疗患者,分为23G玻璃体切割组及20G玻璃体切割组,记录患者术前个人资料包括年龄、性别、糖尿病患病时间、玻璃体出血至手术时间、术前糖化血红蛋白以及眼科检查结果视力、眼压、散瞳眼底情况,并行眼B超检查.两组患者分别行23G及20G玻璃体切割,记录每例患者的手术时间及眼内玻璃体切割操作时间,术后患者1周、1、2、3月复查分别记录视力、眼压、眼底检查、黄斑OCT结果,并进行统计分析.结果 23G玻璃体切割组完成31例,男21例,女10例,平均年龄(65.2±23.7)岁,20G玻璃体切割组26例,男12例,女14例,平均年龄(63.6±18.4)岁,两组对比的手术时间:23G组(74.39±15.61) min,20G组(93.96±18.74) min差异有统计学意义(P＜0.01),眼内玻璃体手术操作时间:23G组(62.35±13.95) min,20G组(59.35±16.07) min,差异有统计学意义(P＞0.05).眼压:术后1d、1周、1、3月复查眼压,23G组分别为(10.46±2.11)、(11.74±2.52)、(14.26±3.11)、(14.85±3.73) mmHg; 20G组(15.20±3.33)、(14.49±3.36)、(14.76±3.50)、(15.62±4.02) mmHg,术后1d、1周眼压两组对比差异有统计学意义.术后黄斑OCT结果:术后1周、1、3个月复查OCT结果,23G组(356.93±88.82)、(313.77±92.21)、(273.74±66.09) μm,20G组(336.50±116.1)、(301.43±100.65)、(283.69±84.39) μm,两组各复查时间点差异无统计学意义(P＞0.05).视力结果:术后3个月两组最佳矫正视力(BCVA),23G组BCVA＜0.05者2只眼;0.05～0.09者5只眼;0.1～0.2者17只眼;≥0.3者只7眼;20G组BCVA＜0.05者2只眼;0.05～0.09者4只眼;0.1～0.2者14只眼;≥0.3者6只眼,两组比较,差异无统计学意义(P＞0.05).23G组手术后出现多量的眼内出血3只眼,1只眼需再次冲洗手术,1只眼术后第1天眼压4 mmHg术后5天发现术眼脉络膜脱离,经激素抗炎治疗逐步吸收.20G组手术后出现多量的眼内出血4只眼,2只眼需再次冲洗手术.结论 23G玻璃体切割手术治疗增殖性糖尿病视网膜病变所致玻璃体出血与20G玻璃体切割手术相比同样有效,完成手术所耗时间更短,但存在术后短期低眼压情况.     

23G微创玻璃体切割术的临床应用

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,观察其疗效及并发症情况。

方法：回顾性分析2011-10/2013-10在我院行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(39.6%),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%)。观察手术前和手术后眼压变化情况、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1～12mo。

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1,7d; 1mo眼压差异均无统计学意义(均为P>0.05); 术后最佳矫正视力均有不同程度提高,与术前比较差异均有显著统计学意义(均为P<0.01)。手术时间70.12±7.86min; 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。     

New technique for removal of perfluorocarbon liquid related sticky silicone oil and literature review

AIM: To investigate the safety and efficacy of sticky silicone oil (SSO) removal using a 22-gauge vein detained needle and inner limiting membrane (ILM) wrap-and-peel technique. METHODS: This retrospective consecutive case series reviewed the records of patients with a history of retinal detachment who had received silicone oil and perfluorocarbon liquid (PFCL) as intraocular tamponades. Patients were included in the analysis if they exhibited SSO remnants during silicone oil removal. The aspiration of most of the SSO remnants was performed by a 22-gauge vein detained needle. The small amounts of droplets adhered to the macula and epi-macular membrane were subsequently removed by the ILM warp-and-peel technique. The anatomical and functional outcomes, and postoperative complications were recorded. In vitro experiments were performed to simulate the formation of SSO remnants in four groups. RESULTS: Of 711 patients who underwent silicone oil removal during the study period, 9 patients exhibited SSO remnants and underwent follow-up for at least 3mo. Seven eyes (78%) underwent the ILM wrap-and-peel technique to completely remove small droplets of SSO that were glued to the macula and epi-macular membrane. No obvious complications occurred. Postoperative optical coherence tomography revealed normal retinal structure in all patients. In vitro analyses showed that balanced salt solution and prolonged vibration (for 1wk) had the strongest effects on silicone oil and PFCL compound opacities. CONCLUSION: SSO remnants could be removed in an intact manner and without complications, using a vein detained needle-assisted and ILM wrap-and-peel technique. The findings suggest that PFCL and infusion fluid should be completely removed before silicone oil injection to prevent SSO formation.     

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的：探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。

方法：回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出; 巩膜扣带术中外加压块采用外加压复合体; 术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。

结果：术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。

结论：改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。     

Application of trigonometric function to calculate the safe movement angle of cannula in 23G double-channel silicone oil removal

AIM: To explore the safe movement angle of a 23-gauge (G) cannula in double-channel silicone oil (SO) removal surgery. METHODS: From March 2017 to September 2017, 15 patients with SO filled eyes were enrolled in this retrospective analysis. Based on ultrasound biomicroscopy (UBM), the distance from the front surface of the sclera at the 2 o’clock and the 10 o’clock positions to the SO bubble at 4 mm behind the corneal limbus was measured and defined as “A”. The length of the 23G cannula (4 mm) was defined as “C”. The width of the scleral inner wall at the maximum operating angle of the scleral trocar was defined as “B”. The safe movement angle of the 23G cannula was determined according to the trigonometric function table. Using the self-made SO removal device connected to the 23G puncture cannula, the SO was successfully removed from all patients. RESULTS: The average SO removal time for all patients was 4.78±0.13min. The trigonometric function was used to work out the distance from the scleral front surface to the SO bubble, which was 0.82-2.81 mm (1.62±0.41 mm) at the 2 o’clock position, and 0.98-2.19 mm (1.71±0.34 mm) at the 10 o’clock position. Finally, the verification analysis using geometric model calculation showed that the optimal movement angle of the cannula was 52°. CONCLUSION: Combining the trigonometric function and UBM measurement to calculate the safe movement angle of a 23G cannula can effectively guide the moving range of the trocar during SO removal. A movement angle of the cannula larger than 50° may avoid the occurrence of a retinal tear.     

三角函数法计算套管安全活动角度在23G双通道硅油取出术的应用

目的：使用UBM在术前测量巩膜前表面到硅油泡的距离,利用三角函数的计算公式,从而计算出23G套管的安全活动角度,最大限度避免术中取油时损伤视网膜。

方法：从2017/03-2017/09,共选取15例硅油眼患者,年龄32～69岁,首次手术均为视网膜脱离,左眼10例,右眼5例,均采用23G套管通过23G灌注管连接5 mL注射器,直接取油的方法。术前均通过UBM测量角膜缘后4 mm,2：00和10：00位的巩膜壁前表面到硅油泡的距离,定义为 “A”; 23G套管的长度为4 mm,定义为 “C”; 将巩膜套管最大活动角度时的巩膜内壁的宽度定义为 “B”; “A”,“B”,“C”构成直角三角形。利用三角函数计算出最大活动角度时“A”和“C”的正弦值,参考三角函数表得出23G套管的安全活动角度。根据此角度指导术中硅油取出时23G套管的活动范围,同时观察取油时间和穿刺口视网膜情况。

结果：所有患者均顺利取出硅油,所用时间平均为4.78±0.13min。穿刺管口处视网膜未见任何新发视网膜裂孔和其他损伤。2：00位巩膜壁前表面到硅油泡的距离为0.82～2.81(1.62±0.41)mm,10：00位为0.98～2.19(1.71±0.34)mm,2：00位巩膜套管的安全活动角度(指套管和巩膜壁的角度)不能低于11～44(24.14±6.95)°,10：00巩膜套管的安全活动角度不能低于14～33(25.45±5.41)°。模拟图形构建,计算穿刺套管安全活动角度为不低于52°。

结论：利用三角函数的方法,结合UBM测量数据,计算套管安全活动角度可以有效的指导23G硅油取出术中套管针的活动范围,本研究建议套管移动角度不要低于50°,可以最大限度的避免医源性裂孔的发生。