25-gauge transconjunctival sutureless vitrectomy system in the surgical management of children with posterior capsular opacification

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.     

25G经结膜无缝合玻璃体切割术系统在先天性白内障中的应用

目的 评价25G经结膜无缝合玻璃体切割手术系统(TSV25G)治疗先天性白内障手术中应用的临床疗效.方法 回顾分析20例29只眼(2～12岁)行超声乳化白内障吸除、TSV25G晶状体后囊膜环形切开前部玻璃体切割和一期人工晶状体植入手术治疗的先天性白内障患者的临床资料.手术后随访2个月至1年,观察术后视力以及后囊膜混浊、虹膜粘连、人工晶状体偏位等术后并发症情况.结果 20例(29只眼)术后视力明显改善,表现为明显视物追踪,视力提高.无虹膜夹持、后囊膜混浊、虹膜后粘连、继发青光眼、人工晶体偏位、黄斑囊样水肿和视网膜脱离等并发症发生.结论 行TSV25G晶体后囊膜环形切开前部玻璃体切割手术应用于先天性白内障的手术治疗,具有手术时间短、创伤小、术后恢复快等优点,能有效抑制后发障发生,有助于视功能的恢复.     

25G玻璃体手术治疗儿童后发性白内障

目的探讨25G玻璃体手术治疗儿童后发性白内障的疗效。方法对7例（10只眼）儿童后发性白内障患者以透明角膜切口插管灌注,TSV25G玻璃体手术行后囊膜切除联合前段玻璃体切除术。术后平均随访23个月,观察视力、眼压、前房反应和并发症的发生情况。结果所有术眼晶状体后囊膜中央均形成直径约4mm的圆形透明区,术中前房稳定,人工晶状体无损伤。全部患儿术后最佳矫正视力均较术前提高。随访期间无切口渗漏、角膜水肿、眼内炎、瞳孔区玻璃体疝、人工晶状体损伤、视网膜脱离、高眼压及晶状体后囊膜切开区再次混浊等并发症。结论 25G玻璃体手术治疗儿童后发性白内障安全、有效、便捷。     

人工晶状体眼后发性白内障的手术

目的探讨巩膜隧道切口插管灌注经睫状体平坦部后囊切开术治疗人工晶状体眼后发性白内障的效果。方法32例(34眼)人工晶状体植入术后后发性白内障行巩膜隧道切口插管灌注经睫状体平坦部后囊切开术。平均随访18个月。结果全部术眼晶状体后囊中央均形成直径3.5~4mm的圆形透明区,后发性白内障切开术的成功率为100%;术中前房稳定,人工晶状体无损伤。术后能配合视力检查的患者最佳矫正视力均恢复至后发性白内障发生前的最佳水平;随访期间无切口渗漏、角膜水肿、瞳孔区玻璃体疝、人工晶状体损伤、视网膜脱离、高眼压或晶状体后囊膜切开区再次浑浊等并发症。结论巩膜隧道切口插管灌注经睫状体平坦部后囊切除术治疗人工晶状体植入术后的后发性白内障安全、有效。     

Acute endophthalmitis after 25-gauge sutureless vitrectomy

Purpose To report a case with acute endophthalmitis as a postoperative complication of 25-gauge transconjunctival sutureless vitrectomy. Methods A 65-year-old gentleman, who underwent 25-gauge sutureless vitrectomy for an idiopathic epiretinal membrane at Beyoğlu Eye Research and Training Hospital, presented with painful loss of vision three days later. For the treatment of acute postoperative endophthalmitis, revitrectomy, phacoemulsification with total capsulectomy and silicone oil injection were performed with intravitreal vancomycin and ceftazidim injections. No predisposing risk factors for endophthalmitis or postoperative hypotony were present. Results Cultures were positive for coagulase negative staphylococcus. He was treated with systemic moxifloxacin and topical ofloxacin, prednisolone acetate postoperatively. Intraocular inflammation resided in 10 days. Silicone oil was removed three months later. At the last visit after 10 months of follow-up, visual acuity increased to 20/63. Conclusions Postoperative endophthalmitis following 25-gauge sutureless vitrectomy occurred after 3 days in the absence of known predisposing factors. Endophthalmitis responded well to antibiotics and vitrectomy with a favorable visual outcome. Unsutured sclerotomies may provide a conduit for bacterial ingress. Preoperative prophylactic antibiotic usage may be considered as a preventive measure in sutureless vitrectomy.     

丝裂霉素抑制后囊膜混浊的实验研究

目的 探讨丝裂霉素抑制后囊膜混浊的有效浓度及可能造成的眼损害和临床应用的可行性。方法 大耳白兔30只,随机分为6组,每组5只,施行晶状体囊外摘出术。对照组用BSS 0．3ml注入囊袋内进行水分离,实验组分别给予0．01％,0．02％,0．03％,0．04％,0．05％丝裂霉素0．3ml注入囊袋内进行水分离。术中均用玻璃酸钠先行保护角膜。随访3个月,处死动物,手术显微镜及光镜观察后囊膜混浊情况、角膜透明度及炎症反应。结果 随访3个月发现,后囊膜混浊多见于术后2个月,时间越长,混浊范围越大。随用药质量浓度增加,后囊膜混浊发生率及严重程度下降,未发现角膜、虹膜及睫状体损伤。结论 囊袋内应用丝裂霉素,并用玻璃酸钠保护角膜内皮,可减少后囊膜混浊发生率且无邻近眼组织损伤。     

双撕囊联合前部玻璃体切除治疗儿童先天性白内障

目的:观察双撕囊联合前部玻璃体切除治疗先天性白内障的疗效。方法:对31例52眼2月龄～12岁先天性白内障患儿实行白内障囊外摘除、后囊连续环形撕囊、前部玻璃体切除术,联合Ⅰ期或Ⅱ期IOL植入,平均随访16mo。结果:31例患儿之中有27例44眼术后能检查视力,最佳矫正视力>0.5者23眼,>0.3者12眼,<0.3者9眼,另外,<2岁的患儿4例8眼无法进行视力表检查,但相对术前跟随光亮或有注视目标的能力有所提高。术后并发症:后发性白内障3眼、葡萄膜炎7眼、角膜水肿5眼,人工晶状体偏位、黄斑囊样水肿、视网膜脱离等严重并发症尚未出现。结论:双撕囊联合前部玻璃体切除术联合IOL植入能预防后发性白内障等并发症的发生,是比较安全有效的治疗儿童先天性白内障的手术方式。     

柔红霉素预防后囊膜混浊的实验研究

目的通过动物在体实验探讨柔红霉素预防后囊膜混浊的作用及其临床可行性。方法采用0．5～10mg·L-1柔红霉素在兔眼晶体囊外摘除术中行囊袋内灌注10min（30例），以20mg·L-1柔红霉素作维持前房灌注（1例）。通过手术显微镜及扫描电镜观察术后眼组织反应。结果随访3mo发现，随用药浓度增加，后囊膜混浊发生率及严重程度下降，未发现角膜损伤及术后葡萄膜反应，较高浓度桑红霉素应用亦未造成明显的角膜内皮细胞改变。结论本研究表明应用桑红霉素1次性眼内灌注可减少后囊膜混浊发生率、且无邻近眼组织损伤。高效。安全、简便的用药特点提示柔红霉素在后覆膜混浊预防中具有临床应用价值及可行性。     

Posterior capsulectomy using a 25-gauge microincision vitrectomy system for preventing secondary opacification after congenital cataract surgery: outcome up to 4 years

Objective: To assess long-term outcomes of posterior capsulectomy using a 25-gauge microincision vitrectomy system (25-GV) for preventing secondary visual axis opacification after congenital cataract surgery.Study Design: Retrospective noncomparative case series.Participants: Nine eyes of 5 children who underwent posterior capsulectomy carried out with the use of a 25-GV during congenital cataract surgery.Methods: After removal of congenital cataract with phacoemulsification and intraocular lens implantation, the posterior capsulectomy was performed using a 25-GV. Postoperative visual outcomes were analyzed.Results: The mean follow-up period was 43.11 (SD 5.53) months. Eight eyes maintained a clear visual axis, but 1 eye required Nd:YAG capsulotomy to enlarge the opening of the capsulectomy at 7 months postoperatively. Postoperative visual acuity was maintained up to 4 years without any other complications.Conclusions: Posterior capsulectomy using a 25-GV offers an option for preventing secondary visual axis opacifica-tion after congenital cataract surgery.     

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.     

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.     

后发性白内障的防治进展

后发性白内障(after cataract)系指白内障囊外摘除术后的主要并发症,又称后囊膜混浊(posterior capsular opacification,PCO)或继发性白内障,简称后发障.本文着重论述白内障手术方式及人工晶状体的选择与后发障的关系及防治.     

晶状体囊袋张力环在预防后囊膜混浊中的应用

后囊膜混浊是白内障摘出联合后房型人工晶状体植入术后导致视力下降的最常见并发症之一 ,而术中植入囊袋张力环可有效地降低后囊膜混浊的发生 ,我们就囊袋张力环在白内障术中的应用及发展情况加以综述     

25G经结膜穿刺法玻璃体切割术治疗特发性黄斑裂孔

目的:探讨小切口玻璃体切割术治疗特发性黄斑裂孔的手术效果。方法:7例(7眼)经眼底及OCT检查确诊为特发性黄斑裂孔,施行25G经结膜穿刺法玻璃体切割术,剥离视网膜前膜,眼内惰性气体填充,观察术后视力及裂孔封闭情况。结果:7例(7眼)黄斑裂孔均解剖复位,2眼视力无改善,5眼视力提高1～4行,随访1～6mo无裂孔复发者。结论:玻璃体切割术是治疗特发性黄斑裂孔的有效方法,经结膜小切口法较传统玻璃体切割术有明显的优势。     

后发性白内障防治的研究

现代白内障手术已成为治疗白内障的确实可靠的方法,但手术后的后囊混浊的高发率严重地影响了患者术后长期拥有良好的视力。因此,如何防治后发性白内障,一直是眼科医生关注的焦点。本文就目前的研究现状作一综述。     

25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study

Background The aim of the study was to evaluate the safety and functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20-gauge vitrectomy system.Methods Forty-six consecutive patients with idiopathic ERM were recruited for this study and prospectively evaluated. In group 1 (n=26) we used a transconjunctival sutureless 25-gauge vitrectomy system (TSV), patients in group 2 (n=20) were operated on using a standard 20-gauge vitrectomy system. The ERM was removed and the internal limiting membrane (ILM) was peeled in all eyes. Surgery-related complications, operating time, intraoperative balanced salt solution (BSS) consumption, postoperative discomfort, postoperative intraocular inflammation, lens opacification, and long-term visual outcome are reported and compared.Results No surgery-related complications were observed in either group. Operating time was shorter in group 1 compared with group 2 (mean 15.6 and 29.6 min respectively). Intraoperative amount of BSS consumption was less in group 1 (mean 28 ml in group 1 and 42 ml in group 2). Postoperative discomfort and intraocular inflammation were significantly reduced in the 25-gauge group. In the 20-gauge group cataract formation requiring surgery was observed in two eyes. Visual acuity improved significantly in both groups. The 25-gauge group improved on average by more lines of vision and the improvement in vision was more rapid.Conclusion The TSV system is a safe and efficient surgical technique for ERM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing postoperative intraocular inflammation and the patients’ discomfort. The incidence of cataract formation may be less using TSV. Postoperative recovery is accelerated.The authors have no financial interests related to this publication.     

白内障术后后囊膜混浊的发生因素

晶状体后囊膜混浊是白内障摘除联合后房型人工晶状体植入术后最常见的并发症,其发生率与人工晶状体的材料、镜片的式样,手术技术等因素均有关。新型的亲水丙烯酸和疏水丙烯酸AcrysofTM人工晶状体由于材料有良好的生物相容性及粘附性能,从而降低了后囊膜混浊的发生率。后凸型的人工晶状体、矩形锐利直角的光学边缘的人工晶状体、小切口白内障超声乳化摘除术、连续环形撕囊可以减少后囊膜混浊的发生率。     

Preserving posterior capsular integrity in post-endothelial keratoplasty posterior capsular opacification

Endothelial keratoplasty (EK) with pseudophakia often presents with late-onset proliferative after-cataract with posterior capsule distension. We performed a modified technique of capsular bag lavage in 11 eyes with late-onset PCO after EK (4 cases: post-DSAEK, 7 cases: post-DMEK). Anterior capsular rim was separated from the underlying IOL optic using MVR blade. Circumferential relaxing radial nicks were made on the capsular rim to create space for the passage of irrigation-aspiration (IA) probes behind the IOL. Bimanual IA of the flocculent cortical material was performed without damaging the posterior capsule. Air was injected at end of surgery to ensure graft apposition. All cases gained 1-3 lines of Snellen’s acuity and no case developed graft failure, rejection, or endothelial decompensation. An intact posterior capsule is associated with better outcomes post a repeat graft, if required. Our technique helps avoid complications related to a disturbed anterior hyaloid phase and minimizes postoperative inflammation.     

后发性白内障的防治新进展

后囊膜混浊(posterior capsule opacification,PCO)又称后发性白内障是现代白内障囊外摘出或超声乳化吸除联合人工晶状体植入术后最常见的晚期并发症,如何防治后发性白内障一直是眼科学者关注的焦点,并不断在此领域取得新的进展。拟对近年来后发性白内障防治中手术方式的改进、人工晶状体自身特性的影响、囊袋张力环的应用、密封囊灌洗技术的开展和基因治疗等方面的研究进展和发展趋势加以综述。     

后囊膜混浊的相关因素分析

目的:探讨在白内障及人工晶状体植入后,后囊膜混浊的相关因素以及预防治疗的方法。方法:根据手术方法分为单纯白内障摘除组及白内障加人工晶状体植入组,后者又根据手术方法的不同及人工晶状体的类型进行比较分析。结果:单纯摘除组与人工晶状体植入组,人工晶状体植入中,不同的手术方法及不同的人工晶状体类型其后囊膜混浊发生的频率及程度均存在较大差异。结论:选择适宜的手术方法(完全封闭技术)、优良的人工晶状体材质(疏水性丙烯酸酯和肝素处理)、特殊的形态设计(锐利边缘)就能最大程度的减少或避免后囊膜混浊的发生。