25G经结膜无缝合玻璃体切割手术系统在黄斑疾病手术治疗中的应用

目的 评估25G经结膜无缝合玻璃体切割手术系统（TSV25G）在黄斑疾病手术治疗中的应用价值。 方法 回顾分析应用TSV25G治疗18例黄斑疾病患者的临床资料。18例患者中，黄斑前膜8例，特发性黄斑裂孔3例，外伤性黄斑裂孔伴黄斑区视网膜下出血3例，玻璃体黄斑牵引综合征2例，糖尿病视网膜病变弥漫性黄斑水肿2例；其中，男13例，女5例，年龄25~73岁，患病时间3.5~30.0个月。手术使用TSV25G，切割速率1500次/min，负压吸引500~550 mm Hg（1mm Hg=0.133kPa），灌注瓶高度40~50cm，手术中眼压维持在29~35 mm Hg。手术后随访2.5~10.0个月。 结果 18例患者均顺利完成手术。手术时间26~44 min，平均手术时间35 min，无玻璃体手术并发症。1例患者手术中穿刺口漏水，用8-0可吸收缝线缝合。手术后平均住院时间3.5 d。6例患者视力恢复到0.8以上，占33.3%。12例手术前有黄斑水肿者手术后3~6个月黄斑水肿完全消退，10例患者视物变形消失，2例患者视物变形减轻；黄斑裂孔患者4例手术后视力无变化，2例视力增加。 结论 TSV25G应用于黄斑疾病手术治疗，手术安全 、省时、效果好。 （中华眼底病杂志，2004，20：137-138）     

23G玻璃体切割手术在高海拔地区的应用

探讨23G玻璃体切割系统在高海拔地区玻璃体切割手术中的应用。 方法:对本院需行玻璃体切割的住院患者31例32眼采用23G玻璃体切割术,包括玻璃体积血、黄斑裂孔、黄斑前膜、晶状体后脱位、视网膜脱离、Tersonz综合征、玻璃体积血合并视网膜脱离。 结果:手术过程顺利,无需扩大巩膜穿刺口,手术后并发症主要是低眼压。 结论:23G经结膜无缝合玻璃体切割系统,与25G玻璃体切割比较效率更高,可以同20G一样处理周边部玻璃体视网膜,同时具有25G免缝合、愈合快、手术时间短、术后并发症少的优点,因此可在高海拔地区玻璃体切割手术中广泛应用。     

应用25G经结膜无缝合玻璃体切割手术系统治疗黄斑裂孔

目的评估应用25G经结膜无缝合玻璃体切割手术系统（TSV205G）治疗黄斑裂孔的疗效及手术实用性。方法回顾分析14例14眼行TSV25G玻璃体切割手术治疗的黄斑裂孔患者的临床资料。14例患者术前均未发生视网膜脱离，其中特发性黄班裂孔8例，外伤性黄斑裂孔4例，高度近视性黄斑裂孔2例。对以上患者应用TSV25G系统行玻璃体切除、剥离黄斑前膜和（或）内界膜、气液交换和15％全氟丙烷（C3F8）眼内填充等治疗。手术后随访1．5m～10m，平均4．2m，主要观察黄斑裂孔闭合情况、术后视力、术中及术后并发症。结果所有手术均在（30～50）分钟顺利完成。14例患者中9眼黄斑裂孔闭合，2眼直径缩小，2眼无变化，1眼出现黄斑裂孔性视网膜脱离。术后视力较术前提高者10眼，不变者2眼，下降者2眼。手术并发症主要为穿刺口漏气导致结膜下气肿及眼压偏低，需要补充注射气体以恢复眼压，此外未观察到其它并发症。结论TSV25G应用于黄斑裂孔的手术治疗具有手术时间短、创伤小、术后恢复快等优点，值得推广。     

经结膜无缝合25G玻璃体切割术灌注系统的临床应用探讨

目的:经结膜无缝合玻璃体切割手术灌注系统应用于常规玻璃体切割术,探讨其临床应用价值及手术适应证,并发症.方法:玻璃体切割术患者196眼(190例),其中孔源性视网膜脱离142眼,单纯玻璃体积血患者20眼,糖尿病视网膜病变伴玻璃体积血26眼,特发性黄斑裂孔或黄斑前膜8眼,随机分层分为2组,每组98眼.一组采用经结膜无缝合玻璃体切割手术灌注系统,另一组采用常规玻璃体切割灌注系统.完成三通道经睫状体平坦部玻璃体切割术.包括黄斑部手术操作,使用20G玻切刀、视网膜钩、镊、笛形针、电凝等进行视网膜周边部操作,内界膜及视网膜前增殖膜剥除,视网膜切开,气液交换,视网膜光凝、冷凝等复杂视网膜手术操作.手术结束时仅缝合玻切刀及光纤头巩膜创口,经结膜无缝合玻璃体切割手术灌注系统穿刺口无需缝合.术后随访2～7 mo.结果:随访期间所有患者均未发现感染性眼内炎及切口持续性渗漏等并发症.采用经结膜无缝合玻璃体切割手术灌注系统患者全部手术时间平均78min,采用常规玻切灌注系统,其平均手术时间为95min,两组差别有统计学意义(P＜0.05)手术后并发症包括视网膜再脱离,一过性眼压升高,玻璃体积血等比较无显著性差异.结论:经结膜无缝合玻璃体切除手术灌注系统应用于常规玻璃体切割术,治疗黄斑疾病,玻璃体积血及视网膜脱离等多种较复杂的疾病,扩大了经结膜无缝合玻璃体切除手术灌注系统的临床应用范围,未观察到与改换灌注系统相关的手术并发症.有效缩短手术时间及减少手术创伤.     

经结膜免缝合20G穿刺套管刀行常规玻璃体切割术的临床观察

目的观察经结膜免缝合20G穿刺套管刀行常规玻璃体切割术的临床效果。方法回顾性分析行玻璃体切割手术62例63只眼的临床资料。按手术方式分为2组,A组：20G经结膜免缝合穿刺套管完成常规玻璃体切割术33例34只眼。男性19例,女性14例;年龄17～75岁,平均年龄52.3岁;平均视力0.04;平均眼压18.25 mm Hg(1 mm Hg=0.133 kPa)。糖尿病视网膜病变（DR）13例;玻璃体积血9例;硅油眼取油剥膜 2例;复杂视网膜脱离9例;黄斑前膜剥离1例。B组：常规20G切口玻璃体切割术29例29只眼。男性13例,女性19例;年龄24～69岁,平均年龄49.5岁;平均视力0.02,平均眼压 17.50 mm Hg。糖尿病视网膜病变10例;单纯玻璃体积血8例;视网膜脱离5例;陈旧性视网膜脱离玻璃体切割联合巩膜环扎2例;硅油眼取油剥膜注气4例。A组34只眼中行眼内激光光凝21只眼,巩膜外冷冻封闭裂孔9只眼;惰性气体填充3只眼,硅油填充15只眼。手术后记录并分析切口渗漏情况,医源性裂孔如发生率及记录患者舒适度。计数资料采用χ2检验。结果 A组34只眼中31只眼穿刺口自闭性良好,无需特别处理,切口无渗漏,手术后舒适度好,3只惰性气体填充眼需压迫3～5 min,且颞下切口均有气体溢出,缝合1针。B组所有患者巩膜结膜切口均8 0丝线缝合,无切口渗漏。异物感明显刺激症状重;舒适度两组比较,差异有统计学意义 (χ2=50.56,P＜0.01);A 组34只眼均未发生医源性裂孔,B组2只眼发生穿刺口旁锯齿缘裂孔,两组比较,差异有统计学意义(χ2=4.15,P＜0.05)。结论经结膜免缝合20G穿刺套管刀行常规玻璃体切割术,使常规玻璃体切割手术简单快捷,显著的减少了医缘性裂孔发生率,使手术更安全。     

继发性与特发性黄斑前膜的手术疗效分析

目的 探讨玻璃体视网膜手术后继发性黄斑前膜的影响因素，比较继发性黄斑前膜与特发性黄斑前膜的手术效果。 方法 分析26例黄斑前膜患者的26只眼（其中玻璃体视网膜手术后继发性黄斑前膜18只眼，特发性黄斑前膜8只眼）行玻璃体切割、黄斑前膜剥离等治疗前后的视力、眼底彩色照相以及部分患者的光相干断层扫描（optical coherence tomography，OCT）检查和随访3~12个月的临床资料。 结果 8例继发性黄斑前膜患者中，与手术有关者9例，占50.0%。巩 膜外冷凝、眼内激光光凝封闭巨大视网膜裂孔手术后继发黄斑前膜差异有显著性的意义（χ2=12.24，P＜0.05）。与玻璃体积血有关的继发性黄斑前膜11例，占61.1%。手术后3个月内视物变形消失者8例，占30.8%；视物变形改善者18例，占69.2% ；两组患者手术后视力均有明显提高。其中，继发性黄斑前膜患者手术后视力平均提高1.33行，最好矫正视力为0.6；特发性黄斑前膜患者手术后视力平均提高3行，最好矫正视力达0.8。 结论 巩膜外冷凝封闭巨大视网膜裂孔、手术前后伴玻璃体积血是玻璃体视网膜手术后继发黄斑前膜的高危因素。特发性黄斑前膜的手术疗效明显好于继发性黄斑前膜。 （中华眼底病杂志，2003，19：90-92）     

25G微创玻璃体手术治疗特发性黄斑裂孔

目的 探讨25G经结膜无缝线微创玻璃体手术(25GTSV)治疗特发性黄斑裂孔的疗效及并发症。方法 采用25CTSV手术系统，对IMH15例15眼，行玻璃体切除术。术后随访1～13个月，平均7个月。结果 15眼均顺利完成手术，手术时间20～25分钟，平均约21．4分钟。15眼中9眼采用表面麻醉，6眼采用球后麻醉。14眼可顺利剥除黄斑裂孔旁内界膜，1眼未能完整的撕除。术后1～6个月行OCT检查，显示15眼中14眼裂孔闭合，1眼裂孔缩小但未闭合，裂孔闭合率为93．3％。术后随访期间未发生裂孔再裂开现象。最后一次随访，术后最佳矫正视力0．1～1．0，平均0．35。9眼(60％)的病人视力至少提高两行。手术并发症包括一过性眼压升高(2眼)、结膜下气泡(2眼)、晶状体后囊下羽毛状混浊(5眼)，晶状体核硬化(2眼)，未发生感染性眼内炎、医源性视网膜裂孔及视网膜脱离、脉络膜脱离以及切口持续性渗漏等并发症。结论 采用25G经结膜无缝线微创玻璃体手术治疗IMH，具有手术时间短、创伤小、并发症少、术后恢复快，手术疗效确切的优点，特别是可在表面麻醉下手术，避免了球后麻醉所引起的并发症，可用于门诊开展IMH的手术治疗。     

视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

视网膜内界膜剥离手术治疗高度近视黄斑裂孔视网膜脱离的疗效观察

目的 观察视网膜内界膜剥离治疗高度近视黄斑裂孔视网膜脱离的疗效. 方法 回顾分析25例25只眼高度近视黄斑裂孔伴视网膜脱离患者的临床资料.根据治疗方法 分为2组,A组为单纯玻璃体切割手术,13例13只眼;B组为玻璃体切割手术加吲哚青绿染色内界膜剥离,12例12只眼.所有患者行惰性气体填充,手术后保持面朝下体位7～15 d.观察最佳矫正分辨角对数(LogMAR)视力,检查眼底,光相干断层扫描(OCT)、B型超声检查视网膜复位及黄斑裂孔闭合情况,比较两组间疗效差异.手术后随访6～18个月,平均随访时间10个月. 结果 A组13只眼中,7只眼手术后视网膜复位,占53.8%;B组12只眼中,11只眼手术后视网膜复位,占91.7%.B组视网膜复位率明显优于A组(X2=4.427,P=0.046);25只眼中,手术后黄斑裂孔闭合者17只眼,占68.0%.其中,A组13只眼中,6只眼黄斑裂孔闭合,占A组患者的46.2%;B组12只眼中,11只眼黄斑裂孔闭合,占B组患者的91.7%.两组患者手术后黄斑裂孔闭合率比较,差异有统计学意义(X2=5.940,P=0.020).A组手术后最佳矫正LogMAR视力提高平均0.32,与手术前比较,差异有统计学意义(Z=-2.045,P=0.041),B组手术后最佳矫正LogMAR视力提高平均0.53,与手术前比较,差异有统计学意义(Z=-2.481,P=0.012).两组间手术后视力差异无统计学意义(U=51.5,P=0.16). 结论玻璃体切割联合视网膜内界膜剥离手术可能通过完全解除玻璃体黄斑牵引、增加视网膜顺应性而提高高度近视黄斑裂孔视网膜脱离的治疗效果.显著增加视网膜复位率及黄斑裂孔闭合率.     

病理性近视黄斑裂孔患者黄斑区视网膜前膜的组织学观察

目的 观察病理性近视内界膜表面结构的组织学变化与黄斑裂孔发生发展的关系.方法 同顾分析行玻璃体切割手术的病理性近视黄斑裂孔患者34例34只眼的临床资料.患眼屈光度均超过-6.00 D,眼轴26.00～33.12 mm,平均眼轴长度27.74 mm.5只眼为黄斑裂孔无视网膜脱离(黄斑裂孔组),29只眼为黄斑裂孔合并后极部视网膜浅脱离(视网膜脱离组).对入选患眼行睫状体平坦部三切口的玻璃体切割手术,手术中观察Weiss环以判断玻璃体后脱离程度,获取34只眼的视网膜前膜及19只眼的内界膜组织标本,行苏木精-伊红(HE)及醋酸铀-枸橼酸铅双染色,采用光学及透射电子显微镜观察.结果 玻璃体切割手术中,5只眼出现Weiss环,24只眼的视网膜表面有多层玻璃体组织残留.光学显微镜观察发现,内界膜表面的视网膜前膜主要由玻璃体胶原纤维.星形胶质细胞及细胞外基质组成.透射电子显微镜观察发现,19只眼的内界膜标本中,5只眼可她内界膜一玻璃体胶原纤维-细胞的"三明治"样结构,1只眼可见内界膜损伤、表面组织牵引和星形胶质细胞移行.结论病理性近视玻璃体后界面劈裂、内界膜表面组织结构的变化是黄斑裂孔发生发展直至视网膜脱离的重要原因.     

Topical anesthesia in transconjunctival sutureless 25-gauge vitrectomy for macular-based disorders

PURPOSE: To evaluate the safety and feasibility of topical anesthesia in vitrectomy using the transconjunctival sutureless 25-gauge system (TSV 25G). METHODS: TSV 25G vitrectomy was performed prospectively in 46 eyes of 46 patients with macular-based disorders, including macular holes (n = 31), idiopathic epiretinal membranes (n = 11), and vitreoretinal traction syndrome (n = 4). Topical anesthesia was administered in each patient by instilling 2% Alcaine at 5 min intervals, three times before surgery. Additional Alcaine drops were given as a supplementation if needed during the operation. The levels of intraoperative analgesia were graded from 1 (adequate) to 3 (inadequate). RESULTS: Thirty-one patients (67.4%) tolerated the procedure well, with no additional anesthetic agent. Thirteen patients (28.3%) required additional topical anesthesia and 2 patients (4.3%) required a systemic sedative. Intraoperative pain occurred when the sclera was pierced by the microcannula and when sclera indentation was performed. No patient required additional retrobulbar or peribulbar anesthesia. There was no intraoperative complication which was specifically related to topical anesthesia. CONCLUSION: Topical anesthesia permits the successful management of some surgically less complex vitreoretinal disorders when the TSV 25G is used.     

The vitreo-retinal interface in macular diseases

Summary  Anomalous posterior vitreous detachment occurs, when the extent of vitreous liquefaction exceeds the degree of weakening of vitreo-retinal adherence and traction is exerted at the vitreo-retinal interface. In the macular region vitreo-macular traction is obviously correlated with macular disorders like macular pucker, epiretinal membrane, macular hole formation, and vitreo-macular traction syndrome. The pathogenesis of diabetic macular edema and exudative age-related macular degeneration is more complex. However, the effectivity of vitrectomy in diabetic macular edema and high incidence of vitreoretinal adhesions in exudative age-related macular degeneration underscore the important role of the vitreous in the pathogenesis of these diseases.      

黄斑前增生性病变的玻璃体手术治疗

目的：探讨黄斑区内表面增生性病变玻璃体手术治疗效果帮并发症的防治,方法,对各种原因所致的黄斑区牵引和皱褶共41例（41只眼）行玻璃体手术治疗。包括特发性黄斑前膜12例,黄斑裂孔合并黄斑前膜形成10例,外伤或视网膜脱离复位术后黄斑皱褶19例（不包括 病性眼底病变或视网膜脱离患者）。术哪找前膜与视网膜之间的潜在性间隙（桥底）或粘连薄弱部位,应用笛形针、视网膜钩、铲、镊等眼内器械,将增生膜和玻璃体后界膜剥离干净。结果：41例术中均顺利剥除黄斑区的视网膜前膜、恢复黄斑区的解部形态,除4例术中,术后发生少量视网膜浅层出血外,未见视网膜撕裂、脱离等并发症。术后视力提高者共38例,3例视力保持原有水平,所有患者视物变形均有明显改善甚视力提高,症状缓解,并发症得到有效控制,术前、术后应用光学相干断层成像术检查,有助于了解黄斑区及增生膜的情况,并进行疗效的客观评价。     

Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy

PURPOSE: To report longer-term outcomes in eyes undergoing 25-gauge transconjunctival sutureless vitrectomy. DESIGN: Retrospective, noncomparative, case series. METHODS: Chart review of the initial 45 consecutive patients (45 eyes) that underwent TSV by one surgeon (T.S.H.) for idiopathic epiretinal membrane (n = 15), refractory diabetic macular edema (n = 11), idiopathic macular hole (n = 10), and nonclearing vitreous hemorrhage (n = 9). All patients had at least 6-month follow-up. Main outcome measures included visual acuity (VA), intraocular pressure, intraoperative complications, and postoperative complications. RESULTS: Mean follow-up was 13 months (range 6 to 25 months). Mean overall preoperative VA vs last postoperative VA was 20/229 and 20/65, respectively (P < .0001). Statistically significant VA improvement was seen for each patient subgroup. Mean preoperative intraocular pressure was 16.9 mm Hg (range 10-26 mm Hg). On postoperative day 1, week 1, and week 4, median intraocular pressure was 14.6 mm Hg (range 8-17 mm Hg), 17.6 mm Hg (range 8-38 mm Hg), and 17.7 mm Hg (range 9-33 mm Hg), respectively. No intraoperative complications occurred. Postoperative complications were 1 inferior retinal detachment (2.2%) 4 weeks after macular hole repair, 1 macular hole (2.2%) 6 months after epiretinal membrane peel, and 23 worsening cataracts in 29 phakic eyes (79.3%). CONCLUSIONS: Less surgically complex vitreoretinal pathology may be successfully repaired with TSV. After a mean follow-up of more than 1 year, minimal complications were seen, and none was specifically related to the sutureless nature of the procedure.     

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.     

The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy

PURPOSE: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases. METHODS: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated. RESULTS: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months) CONCLUSIONS: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.     

Morphology, pathology, and surgery of idiopathic vitreoretinal macular disorders. A review

Macular pucker, the vitreomacular traction syndrome, and impending macular hole are three idiopathic macular disorders sometimes treated by vitreous surgery. Each condition has distinctive clinical features, pathogenic mechanisms, vitreoretinal anatomy, surgical findings, results, and complications. The clinical and pathologic features of these three conditions are compared based on a series of: (1) 101 idiopathic macular pucker cases for which clinicopathologic correlation with transmission electron microscopy (CPC-EM) was available, (2) 24 cases of the vitreomacular traction syndrome (7 patients with CPC-EM), and (3) 43 cases of impending macular hole (7 patients with CPC-EM). All cases of macular pucker, 16 cases of vitreomacular traction syndrome, and 15 cases of impending macular hole have been reported. The median visual acuity for patients with epiretinal membrane and vitreomacular traction syndrome improved from 20/200 preoperatively to 20/70 and 20/50 postoperatively. Macular holes occurred postoperatively in 11 of 43 patients with impending macular hole. The three conditions must be differentiated clinically so that proper recommendations regarding prognosis and possible surgical management can be made.     

应用25G经结膜无缝线玻璃体切割手术系统治疗黄斑前膜

目的 探讨TSV25G(25G经结膜无缝线玻璃体切割手术系统)治疗黄斑前膜的手术疗效及应用价值.方法 15例黄斑前膜,其中特发性黄斑前膜10例,继发性黄斑前膜5例,手术使用美国博士伦公司的Millennium玻璃体切割机与TSV25G系统,经结膜穿刺行玻璃体切割术,剥除黄斑前膜,平均手术时间27min,无玻璃体于小并发症.结果 术后11例患者视物变形消失,4例视物变形明显减轻,黄斑水肿或黄斑皱褶减退或明显减轻.结论 TSV25G治疗黄斑前膜疗效确切.     

Terson综合征13例的临床疗效分析

目的：探讨Terson综合征患者的临床治疗效果。 方法：Terson综合征13例19眼,术前视力光感～0.02,病程1~15(平均7.7)mo。行玻璃体切割术,术中根据玻璃体视网膜情况,采用玻璃体腔内硅油填充2眼,采用气体填充1眼,余采用玻璃体切割灌注液填充。 结果：术中发现玻璃体出血集中在后极部占多数;视网膜前出血12眼（两眼基本对称）,出血在黄斑区4眼,多灶性出血3眼。首次术后19眼视力显著提高,无黄斑区视网膜前出血12眼视力提高到0.4～1.0(平均0.6);有黄斑区视网膜前出血4眼视力提高到0.02～0.4(平均0.3)。前者较后者术后视力显著提高 (P<0.05)。术后随访15眼,约3～26(平均17.6)mo。术后发生视网膜脱离2眼,再次行视网膜复位术。 结论：Terson综合征患者及时行玻璃体视网膜手术安全有效,无黄斑区视网膜前出血较有黄斑区视网膜前出血的患者视力恢复明显。