无菌空气填充治疗大孔径特发性黄斑裂孔的疗效观察

目的:探讨无菌空气填充治疗大孔径特发性黄斑裂孔的安全性和有效性。方法:回顾性研究。共纳入2017-06/2018-05我院收治的特发性黄斑裂孔患者8例9眼,平均黄斑裂孔最小直径>700μm,平均黄斑裂孔基底部直径>1300μm,所有患者均行白内障超声乳化摘除及25G玻璃体切割联合内界膜填塞、无菌空气填充术。平均随访12mo,比较术前和术后最佳矫正视力(BCVA)及黄斑裂孔闭合情况。结果:末次随访时,所有患者黄斑裂孔均闭合,SD-OCT显示术后黄斑裂孔的闭合率为100%(9/9)。术后BCVA(LogMAR)较术前显着改善(0.83±0.26 vs 1.27±0.28),差异有统计学意义(P=0.007)。所有患者术中及术后均未发生并发症。结论:无菌空气填充治疗大孔径特发性黄斑裂孔安全、有效。     

玻璃体手术治疗特发性黄斑裂孔的临床观察

目的:观察玻璃体切割、内界膜剥除联合玻璃体腔气体填充治疗特发性黄斑裂孔的手术疗效及影响因素。方法:对特发性黄斑裂孔患者22例23眼的临床资料进行回顾分析。患眼术前术后除常规检查外最后由光学相干断层扫描(OCT)确诊及测量黄斑裂孔形态。所有患眼均行玻璃体切割、内界膜剥除联合玻璃体腔气体(空气或惰性气体)填充术。观察患者术后视力和黄斑裂孔闭合率及手术并发症的发生情况。用SPSS 13.0统计软件分析患者年龄、病程、术前最佳矫正视力(BCVA)、黄斑裂孔直径、玻璃体腔填充气体种类与术后BCVA和黄斑裂孔闭合率的相关性。结果:术后OCT检查结果显示患者黄斑裂孔闭合率100%。其中术中使用空气进行玻璃体腔填充的14眼,一期黄斑裂孔闭合11眼(79%);术中使用惰性气体(100mL/L C3F8)进行玻璃体腔填充的9眼,一期黄斑裂孔全部闭合,闭合率100%,二者比较,差异无统计学意义(χ2=2.1214,P>0.05)。术后平均矫正视力0.23±0.12,与术前平均矫正视力0.11±0.05相比较,差异有统计学意义(t=4.023,P<0.05)。术后视力提高者术前黄斑裂孔直径小于术后视力不提高者,差异有统计学意义(t=3.92,P<0.05)。术后BCVA与患者年龄(r=-0.415,P=0.256)、病程(r=0.193,P=0.498)、术前BCVA(r=0.152,P=0.673)无相关性。结论:玻璃体切割、内界膜剥除联合玻璃体腔气体填充术治疗特发性黄斑裂孔疗效确切;黄斑裂孔直径是影响特发性黄斑裂孔术后闭合和视力预后的主要因素;而术前视力、年龄、病程对特发性黄斑裂孔术后闭合和视力预后的影响无相关性。     

特发性黄斑裂孔行玻璃体切除联合眼内空气填充术术后黄斑裂孔愈合的观察

目的 观察玻璃体切除联合空气填充治疗特发性黄斑裂孔的疗效.方法 选择我院2016-2018年入院,因特发性黄斑裂孔行玻璃体切除联合空气填充术治疗的患者52例,52眼,观察患者术后24h及1mo黄斑裂孔闭合率,术后俯卧位平均时间及术后并发症,比较患者术前及术后1mo和3mo最佳矫正视力,术前与术后3mo的椭圆体区破坏直径...     

特发性黄斑裂孔玻璃体切割术后视力恢复及黄斑解剖愈合的相关因素分析

目的 探讨特发性黄斑裂孔玻璃体切割术后影响视力恢复及黄斑解剖愈合的相关因素.方法 49例49眼特发性黄斑裂孔行玻璃体切割联合内界膜剥离术的患者纳入本研究.行最佳矫正视力(best corrected visual acuity,BCVA) (logMAR)检查、裂隙灯显微镜及间接检眼镜等检查,同时采用光学相干断层扫描检测黄斑裂孔基底直径、裂孔边缘高度及裂孔最小径,计算黄斑裂孔指数(macular hole index,MHI)、黄斑裂孔牵拉指数(tractional hole index,THI),对黄斑裂孔愈合情况分类.观察术后6个月时视力恢复及黄斑裂孔愈合情况,并与年龄、病程、术前BCVA、裂孔基底直径、裂孔高度、裂孔最小径、MHI、THI等进行相关性分析.结果 术后BCVA为(0.45±0.29) logMAR,与术前BCVA(0.89±0.34) logMAR相比差异具有统计学意义(t=34.2,P=0.000).术后裂孔基底直径为(432.1±90.7) μm,裂孔边缘高度为(214.0±81.3) μm,裂孔最小径为(195.3 ±86.2)μm,均较术前明显减小,差异均有统计学意义(均为P=0.000);术后49眼中,裂孔完全愈合者31眼(63.3％),部分愈合者14眼(28.6％),未愈合者4眼(8.2％).相关性分析结果表明,术后BCVA (logMAR)与年龄、病程、术前BCVA (logMAR)均无相关性(均为P ＞0.05),而与MHI、THI显著相关(r=0.763,P=0.000;r =0.814,P=0.000);黄斑裂孔愈合类型与裂孔基底直径、裂孔边缘高度、裂孔最小径、MHI、THI均显著相关(均为P＜0.05),而与术前BCVA、病程、年龄无相关性(均为P＞0.05).结论 MHI、THI可作为预测术后视力恢复及黄斑裂孔愈合的指标.     

特发性黄斑裂孔玻璃体切除手术联合空气填充的临床观察

目的：通过观察空气填充在特发性黄斑裂孔闭合、黄斑形态和功能变化的情况,得出玻璃体术后空气填充是否是特发性黄斑裂孔值得推荐的填充方式。

方法：采用回顾性分析方法,选择连续手术的特发性黄斑裂孔31例31眼行23G玻璃体切除手术后填充空气,观察患者最佳矫正视力(BCVA)、裂孔闭合、IS/OS破坏直径、手术前后视物变形程度、手术并发症,探讨此类患者玻璃体切除术后空气填充的临床意义及应用价值。

结果：孔径≤250μm的闭合率是100%,孔径250～400μm的闭合率为88.9%,孔径400～600μm的闭合率为93.3%; 最佳矫正视力在基线和术后1、3mo是0.12±0.08,0.28±0.15和0.27±0.18; 手术前IS/OS破坏直径为1962.1±510.7μm,术后3mo,IS/OS破坏直径为1245.3±396.5μm,手术前后IS/OS破坏直径差异有统计学意义(P=0.016); 术后俯卧位时间为3.5±0.4d; 患者视物变形明显改善; 术后未发生严重并发症。

结论：该研究表明,对于特发性黄斑孔而言,空气填充能达到较好的裂孔闭合、视功能恢复、俯卧位时间较短且无严重手术并发症。黄斑裂孔玻璃体切除手术后填充空气是一值得推荐的手术方式。     

特发性黄斑裂孔患者玻璃体术后黄斑结构和中央凹视网膜厚度变化

目的：分析特发性黄斑裂孔患者接受23G玻璃体手术治疗后黄斑结构的修复情况,以及视力和黄斑中央凹视网膜厚度的变化。

方法：将2016-06/2017-12在我院进行择期手术的单眼特发性黄斑裂孔患者85例85眼纳入研究,其中男37例,女48例,平均年龄64.7±10.1岁。所有患者均接受23G玻璃体切割术,应用OCT观察术后黄斑裂孔闭合情况; 应用OCT观察术前和术后1、3、6mo黄斑中央凹视网膜厚度的变化; 观察术前和术后1、3、6mo患者最佳矫正视力的变化。

结果：术后所有患者获得良好的黄斑裂孔闭合。术后3、6mo时所有患者平均最佳矫正视力显著高于术前和术后1mo(P<0.05); 术后6mo平均最佳矫正视力显著高于术后3mo,差异有统计学意义(t=7.983,P=0.037)。术后1mo黄斑中央凹视网膜厚度显著高于术前和术后3、6mo(P<0.05); 术后3、6mo的黄斑中央凹视网膜厚度显著低于术前(P<0.05)。

结论：应用23G玻璃体切除术治疗特发性黄斑裂孔具有较高的裂孔成功闭合率,患者的视力明显提高。     

玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔的疗效及影响因素分析

目的　观察特发性黄斑裂孔行玻璃体切割联合内界膜剥离及消毒空气注入术后的临床疗效，并分析术黄斑裂孔闭合的影响因素。方法　回顾性分析2015年1月至2017年8月在我院诊断为特发性黄斑裂孔并行25 G玻璃体切割联合内界膜剥离及消毒空气注入术的43例43眼患者的临床资料。所有患者术前和术后均行最佳矫正视力（best corrected visual acuity，BCVA）、裂隙灯显微镜及光学相干断层扫描检查。术前测量黄斑裂孔最小直径、裂孔最大基底直径、裂孔高度，并计算裂孔牵拉指数（tractional hole index，THI）及黄斑裂孔指数（macular hole index，MHI）等参数。术后随访3~36个月，观察患眼术后BCVA、黄斑裂孔闭合情况，分析该术式下影响术后黄斑裂孔闭合的相关因素。结果　43例43眼中黄斑裂孔闭合者37眼（86.05%），其中完全闭合29眼，暴露性闭合8眼，未闭合6眼。手术前患眼BCVA为（1.15±0.35）logMAR，术后为（1.04±0.40）logMAR，差异有统计学意义（t=3.197，P=0.003）。术前黄斑裂孔最小直径、最大基底直径与术后BCVA（logMAR）呈正相关，THI及MHI与术后BCVA（logMAR）呈负相关（均为P<0.05）。术后BCVA与术前黄斑裂孔高度无相关性（P=0.339）。当THI＞1.0或MHI＞0.5时，黄斑裂孔闭合率（包括完全闭合和暴露性闭合）为100%，当THI＞0.5或MHI＞0.3时，黄斑裂孔闭合率（包括完全闭合和暴露性闭合）分别为94.74%和97.14%。结论　玻璃体切割联合内界膜剥离及消毒空气注入术治疗特发性黄斑裂孔临床疗效较好，THI、 MHI是影响黄斑裂孔闭合的重要指标。     

玻璃体切除术治疗外伤性黄斑孔的疗效分析

目的 对玻璃体切除术治疗外伤性黄斑孔的疗效进行同顾性分析.方法 回顾性分析2000年至2008年期间接受玻璃体切除治疗的外伤性黄斑孔病例共95例95只眼.均接受标准的扁平部玻璃体切割、气体填充联合或不联合内界膜( ILM)剥除及血小板封孔术.比较手术前后孔的闭合情况及视力的恢复情况.结果 术前平均病程为(9.8±21.8)个月,平均孔径为(644.2±270.5)μm,平均最佳矫正视力(BCVA)为0.12±0.1( 1.1±0.45 )logMAR.术后平均随访(96± 131)d,患者视力提高69只眼(72.6％)、不变19只眼(20％)、下降7只眼(7.4％).术后BCVA平均为0.22±0.19(0.83±0.40)logMAR,比术前显著提高.术后BCVA达0.2以上者46只眼(48.4％).单次手术后孔闭合率为100％.结论 玻璃体切除术治疗外伤性黄斑孔能有效促进裂孔闭合,提高视力.     

25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔疗效评估

目的 探讨25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔的临床疗效.方法 回顾性分析2014年5月至2016年8月在丽水市人民医院眼科行25G玻璃体切割术的黄斑裂孔患者28例28只眼的临床资料,所有患者行25G玻璃体切割,在0.25 mg/ml亮蓝染色下剥除内界膜,玻璃体腔内消毒空气填充.术后主要观察手术时间、最佳矫正视力、眼压、裂孔闭合情况及手术并发症.术后随访3～24个月,平均（12.23.6）个月.结果 总手术时间为22～40 min,平均28 min,28只眼内界膜均顺利剥除,28例患者黄斑裂孔均闭合（100％）,21例患者术后视力较术前均有提高（75％）,无视力下降患者,平均视力为0.650.194,与术前相比显著提高（t=13.768,P=0.000）.术后1周平均眼压为（15.33.7） mmHg,与术前水平相近.8只眼剥除IMH时视网膜表面少量细小点状出血,4只眼术后随访期间发生核性白内障,3只眼发生一过性高眼压.所有病例在随访期内无其它严重并发症发生.结论 25G玻璃体切割联合内界膜剥除及空气填充治疗特发性黄斑裂孔,能促进裂孔愈合,提高术后视力,缩短手术时间,减少并发症,是一种安全有效的微创手术方法.     

白内障摘除联合玻璃体切除内界膜剥除术治疗非黄斑裂孔超高度近视性黄斑劈裂

目的:评价白内障摘除联合玻璃体切除内界膜剥除术治疗非黄斑裂孔超高度近视性黄斑劈裂的疗效.方法:回顾性分析.选取我院收治的非黄斑裂孔超高度近视性黄斑劈裂患者32例32眼,屈光度为-12.00~-20.00(平均-15.78±2.16)D.平均最佳矫正视力(LogMAR) 4.1±0.4.所有患者均行白内障超声乳化吸出人工晶状体植入联合玻璃体切除内界膜剥除术,内界膜采用吲哚菁绿染色并顺利剥除,术毕进行气体填充.术后随访1~9(平均4.5)mo,观察术后视力及黄斑劈裂愈合效果.结果:共30例30眼(94%)患者劈裂腔消失,视力较术前提高,视物变形改善.手术前后最佳矫正视力比较,差异具有统计学意义(t=-7.91,P<0.05).结论:白内障超声乳化吸出人工晶状体植入联合玻璃体切除内界膜剥除术是治疗非黄斑裂孔超高度近视性黄斑劈裂安全有效的手术方法,可有效保存视功能,不同程度提高患者的视力.     

Outcomes of 25-gauge vitrectomy with air tamponade for idiopathic macular hole repair surgery

AIM: To evaluate the anatomic and visual outcomes of 25-gauge vitrectomy combined with air tamponade for the treatment of idiopathic macular hole (IMH). METHODS: Thirty eyes of 27 patients with IMH were included in this prospective interventional study. All patients underwent 25-gauge pars plana vitrectomy (PPV) combined with phacoemulsification and air tamponade. Best corrected visual acuity [BCVA; logarithm of the minimum angle of resolution (logMAR)], perimetry and multifocal electroretinography (mfERG) were conducted before and after the operation. Anatomical changes were evaluated with optical coherence tomography (OCT). RESULTS: The macular holes closed successfully in 28 eyes after the primary vitrectomy. The mean BCVA improved from 0.72±0.22 logMAR preoperatively to 0.29±0.18 logMAR postoperatively (P<0.001). In the visual field of central 10°, the average mean deviation (MD) decreased from -3.59±1.83 dB preoperatively to -2.51±1.36 dB postoperatively (P<0.001) and the average pattern standard deviation (PSD) decreased from 1.86±0.68 dB preoperatively to 1.33±0.32 dB postoperatively (P=0.001). The retinal response densities of mfERG in the foveal and perifoveal area increased significantly, and implicit times of rings 4-6 prolonged significantly too (P<0.05). The symptom duration and baseline N1 amplitude densities at ring 1 had a significant impact on postoperative BCVA (P<0.001, P=0.001, respectively). CONCLUSION: The 25-gauge PPV and air tamponade with 1d prone positioning produced favorable anatomic and functional outcomes.     

玻璃体切割联合内界膜瓣覆盖术中行球内无菌空气填充治疗特发性黄斑裂孔

目的：比较无菌空气填充和C₃F₈填充在玻璃体切割(PPV)联合内界膜瓣(ILMF)覆盖术中治疗特发性黄斑裂孔(IMH)的疗效差异。

方法：回顾性对照研究。选取武汉大学人民医院眼科2014-01/2017-06就诊的符合纳入标准的IMH患者,行PPV联合黄斑区ILMF翻转覆盖黄斑裂孔术,根据术中是否行C₃F₈填充,分为球内空气填充组(A组112眼)和球内C₃F₈填充组(B组63眼),比较两组术后高眼压发生情况、黄斑裂孔闭合率、术后1、3mo时最佳矫正视力(BCVA)和黄斑区结构重建情况。

结果：A组和B组在术后1、3mo时,较术前BCVA均有提高,差异有统计学意义(P<0.05); 两组手术后1mo时BCVA比较差异均无统计学意义,术后3mo时,A组BCVA较B组恢复更佳,差异具有统计学意义(P<0.05); A组黄斑裂孔闭合率为97.5%,B组为96.8%,两组比较差异无统计学意义; 两组的光感受器细胞内外节交界面连接带(EZ)缺损直径较术前均有明显减小,差异有统计学意义(P<0.05),在术后1、3mo时两组比较,差异均无统计学意义; B组术后高眼压发生率为9.5%,而A组无术后高眼压情况发生,两者差异有统计学意义(P<0.05)。

结论：PPV联合ILMF覆盖治疗特发性黄斑裂孔安全有效,玻璃体腔无菌空气填充可减少术后高眼压发生率,在该手术中可以代替C₃F₈填充。     

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy

AIM: To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS: A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS: The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1st day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP(8 mm Hg) was not different between groups in the postoperative 1st day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION: Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.     

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。     

无染色剂下视网膜内界膜剥离联合笛针吸引治疗特发性黄斑裂孔

目的:探讨玻璃体切割(PPV)联合无染色剂下视网膜内界膜剥离(ILMP)、笛针吸引、空气填充术治疗特发性黄斑裂孔(IMH)的临床疗效。方法:回顾性非随机对照研究。选取2018-01/2019-01在我院确诊的IMH患者76例76眼,按手术方式分为两组,其中38眼行PPV联合无染色剂下ILMP、空气填充术(A组),38眼行PPV联合无染色剂下ILMP、笛针吸引、空气填充术(B组)。术后随访6mo以上,观察两组患者黄斑裂孔闭合、最佳矫正视力(BCVA)及并发症发生情况。结果:术后6mo,A组患者黄斑裂孔闭合率和BCVA提高率均显著低于B组(84%vs 100%,76%vs 95%,均P<0.05)。随着术后时间的推移,两组患者BCVA逐渐改善,且术后7、14d,1、3、6mo B组患者BCVA优于A组(均P<0.05)。术后随访期间,两组患者均未出现严重并发症。结论:无染色剂下ILMP联合笛针吸引治疗IMH临床疗效确切,在裂孔闭合率及BCVA改善方面明显优于单纯ILMP组。     

25G玻璃体切除联合空气填充术治疗孔源性视网膜脱离

目的:观察玻璃体切除联合空气填充术治疗孔源性视网膜脱离的临床疗效,评价空气填充的有效性及安全性。方法:对2017-08/2018-12就诊于遵义市第一人民医院的孔源性视网膜脱离并接受玻璃体切除联合空气填充术的患者30例30眼进行回顾性分析,观察术眼术前、术后1 wk,1 mo最佳矫正视力(BCVA,LogMAR)、眼压、术后视网膜复位情况及术后并发症情况等。结果:术前,术后1wk,1mo BCVA分别为0.87±0.71、0.64±0.36、0.37±0.22,手术前后术眼BCVA有差异(F=3.74,P=0.047)。术前,术后1wk,末次随访眼压分别为13.61±3.57、15.74±4.84、14.05±2.88mmHg,手术前后眼压无差异(F=4.13,P=0.051)。术后1wk视网膜复位率97%(29/30)。术后OCT监测1眼出现持续视网膜下积液,术后3mo积液吸收。结论:玻璃体切除联合空气填充术治疗孔源性视网膜脱离疗效确切,术后恢复快,提高视觉质量,同时减少患者经济负担。     

Primary repair of retinal detachment with 25-gauge pars plana vitrectomy

PURPOSE: To evaluate 25-gauge pars plana vitrectomy (PPV) for primary repair of rhegmatogenous retinal detachment (RRD). STUDY DESIGN AND PARTICIPANTS: This retrospective, consecutive case series included 42 eyes of 41 patients who underwent primary repair of RRD utilizing transconjunctival 25-gauge PPV without scleral buckling at the Cincinnati Eye Institute from July 2004 through January 2007. METHODS: The medical records were retrospectively reviewed, and the corresponding demographic data, preoperative ophthalmic diagnoses, surgical management, and postoperative course and treatment were recorded. Main outcome measures included single surgery anatomical success, preoperative and postoperative visual acuity, and complications. RESULTS: Most patients had pseudophakic RRD (36 [85.7%] of 42 eyes). The crystalline lens was present in the remaining 6 eyes (14.3%). Of 42 eyes, 28 (66.7%) had macula-on RRD, while 14 (33.3%) had macula-off RRD. Four surgeons contributed to this study, and 25-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and gas tamponade were used in each case. The single surgery anatomical success rate was 92.9% (39 of 42 eyes). For eyes with macula-on RRD, best-corrected visual acuity was 20/50 (0.43 logMAR [logarithm of the minimum angle of resolution]) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.24). For eyes with macula-off RRD, best-corrected visual acuity was 5/200 (1.56 logMAR) preoperatively and 20/30 (0.23 logMAR) postoperatively (P = 0.001). Three eyes required additional surgery for final reattachment. Final reattachment was achieved in 100% of patients (mean follow-up, 8 months). CONCLUSIONS: Twenty-five-gauge PPV with laser retinopexy and gas tamponade is effective for primary repair of RRD. The single operation anatomical success rate is comparable with rates reported for primary vitrectomy with 20-gauge instrumentation, scleral buckling, and combined vitrectomy/scleral buckling.     

玻璃体切割联合内界膜填塞及鼠神经生长因子注射治疗大直径特发性黄斑裂孔

目的：观察玻璃体切割术(PPV)联合内界膜(ILM)填塞及鼠神经生长因子(NGF)注射治疗大直径特发性黄斑裂孔(IMH)的临床疗效。

方法：回顾性病例研究。选取2018-05/2020-05在南京医科大学眼科医院检查确诊并行PPV联合ILM填塞及鼠NGF注射的大直径IMH患者16例16眼纳入研究。所有入组患者均接受经睫状体扁平部三通道23G PPV联合ILM填塞及鼠NGF注射治疗。观察术后最佳矫正视力\〖BCVA(LogMAR)\〗、裂孔闭合率、分析黄斑裂孔闭合的OCT分型、中心凹外层结构包括椭圆体带(EZ)、外界膜(ELM)的连续性及术后并发症等。

结果：患者术前BCVA为1.15±0.21,术后3、6mo BCVA分别为1.02±0.19、0.87±0.24(F=34.966,P<0.01); 术后3、6mo BCVA较术前均有改善(P<0.01),且术后6mo BCVA较术后3mo改善(P<0.01)。术后患者裂孔闭合率为100%,OCT所显示的闭合形态中,11眼为U型闭合(69%); 3眼为V型闭合(19%); 2眼为不规则闭合(13%)。术后6mo,U型、V型及不规则闭合组眼的BCVA分别为0.75±0.18、1.1±0.19、1.20±0.00(F=6.937, P<0.01),其中U型闭合组的BCVA恢复明显优于V型闭合组和不规则闭合组(P=0.027、0.007)。术后6mo,U形闭合组中有10眼(91%)ELM恢复连续性、7眼(64%)EZ恢复连续性,V型闭合组中有2眼(67%)ELM恢复连续性、1眼(33%)EZ恢复连续性,不规则闭合眼中未见ELM、EZ连续性恢复(P<0.05)。随访期间未发现眼部及全身并发症。

结论：PPV联合ILM填塞及鼠NGF注射治疗对大直径IMH安全有效,NGF与ILM的协同作用可促进裂孔的闭合,有利于视网膜光感受器细胞的完整性恢复及术后视功能的改善。     

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM: To evaluate the postoperative intraocular lens (IOL) rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL. METHODS: In this retrospective case series, 32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter (D). A plate haptic toric IOL (AT Torbi 709M, Carl Zeiss Meditec AG) was implanted in all eyes. The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity (BCVA). RESULTS: Preoperative refractive astigmatism was 2.14±1.17 D, which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period (0.67±0.44 D at three months and 0.75±0.25 D at six months; for all groups: P<0.0001 compared to baseline). BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery (P=0.02). Mean IOL axis deviation from the target axis was 3.4°±2.9° after six to eight weeks and significantly decreased over time (2.4°±2.6° six months after surgery; P=0.04). In one patient IOL, re-alignment was performed. CONCLUSION: Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery. The plate haptic toric IOL position and axis remain stable during the observation period of six months.