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1.
目的:通过研究接受23G经结膜无缝合玻璃体切割手术(23-gauge transconjunctival sutureless vitrectomy,TSV23G)患者,评价是否联合白内障超声乳化人工晶状体植入术、不同玻璃体腔填充物、术后恢复时间(术后1d;1,3mo)等因素对视力和眼内压的影响,为临床选择手术方式及评价疗效提供参考。方法:应用多元相关和回归分析56例57眼视力及眼压的临床资料。结果:视力与联合术式、术后1,3mo呈正相关,与非联合术式、术后1d、填充物的使用呈负相关。其中气体填充物、硅油填充物、术后1,3mo与视力的相关系数具有统计学意义(P=0.0005,0.0006,0.0461,0.0210)。眼内压与联合手术、术后1d;1mo、气体填充物呈正相关,与视力、未联合手术方式、术后3mo、硅油填充物呈负相关。其中,视力、手术方式、术后3mo与眼内压的相关系数有统计学意义(P=0.0038,0.0023,<0.01)。结论:行TSV23G后部玻璃体切割术联合白内障超声乳化人工晶状体植入术有利于患者的视力提高。惰性气体对于眼内压影响明显。术后视力随时间好转,眼内压早期升高,术后3mo降低。就本研究而言,术后3mo是评价手术后疗效的适宜时间。  相似文献   

2.
张燕 《国际眼科杂志》2012,12(5):944-945
目的:评估23G经结膜无缝线玻璃体切割手术治疗孔源性视网膜脱离的安全性及有效性。 方法:前瞻性选择2010-03/2011-06共26例26眼不伴有严重增生性病变的孔源性视网膜脱离病历,均行23G切割手术。记录术前、术后的最佳矫正视力(BCVA)、眼压,术中及术后并发症。 结果:一次性复位视网膜21例(81%),最终复位视网膜25例(96%)。术后3mo最佳矫正视力较术前提高21例(80%),不变3例(12%),下降2例(8%)。术后1d眼压较术前下降,此差异有统计学意义(P<0.01)。低眼压(≤6mmHg)2例,持续2wk,但未发生脉络膜脱离。 结论:23G手术治疗孔源性视网膜脱离解剖复位率满意,术后视力改善明显。但23G微创手术的优势并没有在孔源性视网膜脱离的手术中得到充分体现,反而要面临更高的手术失败的风险。  相似文献   

3.
23G玻璃体切割手术系统治疗婴幼儿先天性白内障   总被引:1,自引:0,他引:1  
目的探讨23G经结膜无缝合玻璃体切割系统行晶状体切除联合前段玻璃体切割术治疗婴幼儿先天性白内障的疗效。方法对26例(43只眼)先天性白内障施行23GTVS晶状体切除并前段玻璃体切割术,随访观察术后眼部情况。结果采用该手术方式治疗婴儿先天性白内障,术后患儿眼部反应轻微,无纤维素性渗出,并发症少,减轻了术后护理的难度。结论应用23GTVS行晶状体切除联合前段玻璃体切割术治疗婴幼儿先天性白内障,操作简单,术后视觉通路保持良好,具有较好的临床应用效果。  相似文献   

4.
目的:观察改良23G经结膜免缝合微切口玻璃体切除手术(TSV)后早期(7d内)高眼压发生率及其影响因素。

方法:回顾性病例分析研究。选取2013-03/11在我院行改良23G免缝合微切口玻璃体切除手术的98例98眼纳入研究。采用非接触式眼压计测量眼压在25mmHg以上的术眼临床资料进行分析。连续监测手术后7d的眼压情况,分析患者年龄、性别、眼别、病程及手术前原发疾病、眼内手术史、手术方式、不同眼内填充物、晶状体状态及手术时间对手术后高眼压发生的影响。

结果:23G玻璃体切除术后7d内共33眼出现高眼压,发生率是33.7%(33/98),其中,发生在术后第1d者8眼,占24.2%(8/33),术后3d者25眼,占75.8%(25/33)。男、女高眼压的发生率分别为32.8%(20/61)和35.1%(13/37),右、左眼高眼压发生率分别是36.8%(21/57)和29.3%(12/41)。高眼压眼与无高眼压眼年龄(Z=-0.22),性别(χ2=0.057)、手术眼别(χ2=0.612),病程(Z=-0. 079)及手术时间(Z=-0.553)比较,差异均无统计学意义(P>0.05)。硅油眼和气体填充眼比较(χ2=1.04)、外伤眼和非外伤眼比较(χ2=0.044),视网膜脱离眼和非视网膜脱离眼比较(χ2=2.282),差异亦无统计学意义(P>0.05)。多次手术眼比首次手术眼高眼压发生率高(χ2=5.211),联合手术较单纯玻璃体手术高(χ2=4.57),无晶状体眼较有晶状体眼高(χ2=4.224),差异有统计学意义(P<0.05)。

结论:23G免缝合微切口玻璃体切除术后高眼压主要发生在术后前3d。眼内手术史,联合手术,无晶状体眼是手术后高眼压的危险因素。  相似文献   


5.

Purpose

The development of 23-gauge vitrectomy surgery has many benefits including a reduction in surgical time and faster postoperative rehabilitation; however, some have suggested that the complication rate is higher. To assess this we compared the incidence and distribution of iatrogenic retinal tears in 20- and 23-gauge surgery.

Methods

Fifty consecutive 23-gauge and 50 consecutive 20-gauge vitrectomy cases were selected; eyes with a history of previous vitreoretinal surgery were excluded. All surgery was performed by two surgeons (JL and RN). Entry-site breaks (ESB) were defined as any new vitreoretinal abnormality occurring within 1 clock hour of an entry site for which treatment with cryotherapy was deemed necessary. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher''s exact and χ2-tests.

Results

ESB occurred in 24% (12/50) of cases in the 20-gauge group compared with 8% (4/50) in the 23-gauge group (P=0.03); 88% (14/16) occurred superiorly on the same side as the surgeons'' dominant hand. Iatrogenic breaks recorded elsewhere indicated an increased incidence in the 20-gauge group (9/50 compared with 6/50 in 23-gauge) but this did not achieve significance; the most common position was at 6 o''clock.

Conclusions

23-Gauge vitrectomy is associated with significantly fewer ESB when compared with conventional 20-gauge vitrectomy. The incidence of other iatrogenic breaks did not appear to be significantly different between the two groups.  相似文献   

6.

Aims

To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases.

Settings and Design

Ege university hospital ophthalmology department. Retrospective case series.

Materials and Methods

Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated.

Statistical analysis used

Paired Student''s t-test.

Results

Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively (P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) (P<0.001).

Conclusions

Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.  相似文献   

7.
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。  相似文献   

8.
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.  相似文献   

9.
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.  相似文献   

10.
The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy. Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems. We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.  相似文献   

11.
目的评价23G玻璃体切除器在治疗Terson综合征中的作用及手术时机对预后的影响。方法应用23G玻璃体切除器,部分配合剥膜、眼内光凝、玻璃体腔内注空气或C3F8等治疗Terson综合征11例(18眼)。结果所有患者术后玻璃体腔清晰,视力较术前均有提高。结论23G玻璃体切除器治疗Terson综合征玻璃体积血,手术并发症少,恢复快,手术时机越早者视力预后越好。  相似文献   

12.
目的:探讨23G微创玻璃体切割技术在临床中的应用价值。方法:回顾23G微创玻璃体切除术治疗的玻璃体视网膜疾病患者140例140眼,随访1mo记录手术方式、术中情况、手术时间、手术效果、视力、眼压、手术并发症及角膜内皮密度。结果:(1)初次手术成功率100%,1mo复发率为0.71%,随访期间未发现感染性眼内炎及持续性切口渗漏等并发症;(2)手术时间20~95(平均46min);(3)住院时间3~39(平均7)d;(4)91.43%患者术后视力较术前有不同程度提高,最佳矫正视力为0.7,术前、术后视力比较有显著性差异(P<0.01);(5)眼压:术后1d眼压与术后5d相比,差异有显著统计学意义(P<0.01);术后1d眼压与术后1mo相比,无统计学差异(P>0.05);术后5d与术后1mo相比,有统计学差异(P<0.05);(6)角膜内皮密度(个/mm2):术前2735.49±319.28,术后1mo2694.14±354.08,无统计学差异(P>0.05)。结论:23G微创玻璃体切割技术具有手术时间短、术后恢复快、手术并发症少、应用范围广等优点,临床应用前景好。  相似文献   

13.
PURPOSE: To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children. METHODS: Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded. RESULTS: Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system. CONCLUSIONS: Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.  相似文献   

14.
AIM: To introduce and evaluate the clinical efficacy of a new technique, the use of viscoelastic substances (VS) to close leaking sclerotomy in 23G microincision vitrectomy, and to observe its effect on the visual acuity and intraocular pressure (IOP) of patients. METHODS: Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique (June 2019 to September 2020) and after the use of VS technique (October 2020 to December 2021) were selected as the subjects of this study. The above cases underwent operation by the same surgeon and were retrospectively analyzed. VS technique was used as the alternative to suturing, in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure. RESULTS: A total of 174 eyes were covered in the study, including 84 eyes in the control group (before the use of VS technique) and 90 eyes in the VS technique group. The number of eyes that needed to be sutured decreased considerably from 42.9% in the control group to 3.3% in the VS technique group, and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7% in the control group to 2.2% in the VS technique group. No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group. No major complications associated with VS technique were identified during the study. CONCLUSION: In 23G microincision vitrectomy, VS technique is a safe, simple, and effective method to close leaking sclerotomy.  相似文献   

15.
16.
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。  相似文献   

17.
目的 观察25G玻璃体切割术穿刺口缝合与免缝合术后眼压及其并发症发生情况,探讨小切口玻璃体切割术穿刺口缝合的必要性。方法 连续收集2015年5月至2016年9月西京医院眼科住院部206例(206眼)接受25G三通道玻璃体切割术患者的病例资料。根据手术结束时是否缝合巩膜切口分为2组,缝合组106例,免缝组100例。以术后第1天眼压≤5 mmHg(1 kPa=7.5 mmHg)为极低眼压,眼压>21 mmHg为高眼压,术后高眼压在程度上分为:轻度>22~30 mmHg,中度>30~40 mmHg,重度>40 mmHg。术后眼压等级变化(眼压变化幅度)分为:无变化、轻度降低(降1级)、重度降低(降2级)、轻度升高(升1级)、重度升高(升2级)。重点关注患者术后第1天眼压以及术后极低眼压和高眼压以及并发症的发生情况。结果 术后第1天缝合组眼压为4.7~48.0 mmHg (16.68±8.21)mmHg,免缝组为2.3~45.0 mmHg (14.41±7.72) mmHg,差异有统计学意义(P=0.031),免缝组术后第1天眼压总体低于缝合组。两组术后眼压等级比较,差异有统计学意义(P=0.029),免缝组术后发生极低眼压概率高,缝合组发生高眼压的概率高,缝合组术后眼压在正常范围内的概率大于免缝组。两组手术前后眼压等级变化(眼压变化幅度)比较,差异无统计学意义(P=0.120)。本研究资料术后极低眼压发生率为4.3%。免缝组出现8眼极低眼压,其中5眼发生并发症,包括术后第1天出现视网膜皱褶、脉络膜脱离1眼,4眼出现前房出血。缝合组出现1眼极低眼压,术后第1天可见前房出血及脉络膜水肿。两组手术后极低眼压并发症发生率差异有统计学意义(P=0.028),免缝组较缝合组术后发生极低眼压导致并发症发生率高。本研究资料高眼压发生率为14.1%。免缝组高眼压共12眼,其中轻度7眼、中度3眼、重度2眼。缝合组高眼压共17眼,其中轻度9眼、中度5眼、重度3眼。缝合组比免缝组高眼压发生率相对较高,但两组术后均未出现高眼压导致的并发症。两组术后高眼压程度差异无统计学意义(P=0.805),眼压以轻中度升高为主,经治疗3 d后,眼压均降到正常范围内。结论 25G玻璃体切割术毕时缝合穿刺口是相对更安全的,为了防止术后极发生低眼压及并发症,针对性缝合穿刺口是有必要的。  相似文献   

18.
AIM: To report the cytology results of 25-gauge transconjunctival (25G-TSV) diagnostic vitrectomy in cases suspicious for intraocular lymphoma (IOL), and compare the results to those reported in the literature.METHODS: Clinical and cytopathological records of 18 vitreous biopsy specimens obtained via 25G-TSV diagnostic vitrectomy in 12 patients suspicious for IOL were reviewed retrospectively. A review of the literature in regards to the diagnostic yields of vitreous specimens obtained via 25-gauge and 20-gauge diagnostic vitrectomy in suspected cases of IOL was performed.RESULTS: Eighteen eyes from 12 patients with clinical suspicion of IOL underwent diagnostic 25G-TSV. The cytopathological investigations demonstrated IOL in 15 eyes (83.3%). Vitreous analysis was non-diagnostic in 3 eyes (16.7%).CONCLUSION: Twenty-five-gauge diagnostic vitrectomy yields adequate sample for cytological evaluation of the vitreous in cases suspicious for IOL. The diagnostic results of the 25G-TSV in the current study are superior to those reported for 20-gauge vitrectomy but equivalent to those reported for 25G-TSV in the published literature.  相似文献   

19.
目的:探讨23G微创玻璃体切割术(23G TSV)治疗复杂黄斑裂孔的临床效果.方法:收集我院2013-01/2015-06期间眼科收治的80例80眼黄斑裂孔患者为研究对象,采用随机平行对照法将其分为对照组和观察组各40例.对照组采用20 G玻璃体手术治疗,观察组采用23 G结膜无缝合玻璃体手术治疗.比较两组手术时间、住院时间、治疗前后视力变化、黄斑裂孔闭合及黄斑厚度、并发症等情况.结果:观察组患者手术时间及住院时间显著短于对照组,且术后并发症发生率显著低于对照组,差异具有统计学意义(P<0.05).两组患者术后3、6、12mo矫正视力较术前均有显著提高,组内比较差异具有统计学意义(P<0.05),但是组间比较差异无统计学意义(P>0.05).观察组黄斑裂孔闭合率为98%(39/40),对照组黄斑裂孔闭合率为95%(38/40),差异无统计学意义(χ2=0.346,P=0.553).两组患者术后3、6、12 mo黄斑厚度较术前均有明显下降,组内比较差异具有统计学意义(P<0.05),但是组间比较差异无统计学意义(P>0.05).结论:23 G TSV治疗特发性黄斑裂孔具有效果显著,并发症率低,有利于促进术后视力恢复和改善预后.  相似文献   

20.
目的:报告23G玻璃体视网膜手术治疗孔源性视网膜脱离(rhegmatogenous retinal detachment,RRD)的有效性和安全性。 方法:本回顾性研究中,49例49眼RRD患者于2007-01/2009-07在我院行23G经巩膜无缝线玻璃体切除术纳入研究。 结果:平均随访时间8.9±7.7mo(1~28mo)。47眼(95.9%)视网膜再次脱离经一次手术治愈,2眼因新出现裂孔的视网膜再次脱离通过23G经巩膜无缝线玻璃体切除术治愈。术前平均logMAR视力2.01±0.47,术后1.3±0.5(P<0.001, Paired t-test)。术前平均眼压(intraocular pressure,IOP)14.1±2.8mmHg,术后1d平均眼压12.3±3.6mmHg,术后1wk平均眼压13.1±2.1mmHg,术后1mo平均眼压14.3±2.2mmHg。术中医源性周边视网膜裂孔1眼(2.0%)。巩膜或结膜切口不要求缝合,无1眼需要转换为20G玻璃体切除术。 结论:23G经巩膜无缝线玻璃体切除术可以有效,安全的治疗RRD。  相似文献   

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