27G玻璃体切除术治疗视网膜分支静脉阻塞继发玻璃体积血的临床疗效和安全性探讨

目的探讨27G玻璃体切除术治疗视网膜分支静脉阻塞继发玻璃体积血的临床疗效及安全性。方法回顾性分析27G玻璃体切除治疗视网膜分支静脉阻塞所致玻璃体积血患者33例(33眼)的临床资料,术后随访1个月。对比术前、术后1周和1个月的最佳矫正视力(best corrected visual acuity,BCVA)和眼压变化,记录玻璃体切除时间、切口缝合和渗漏情况,术中及术后并发症等情况。结果玻璃体切除平均时间为(16.30±4.10)min。术后1周和1个月术眼的BCVA均较术前提高,差异有统计学意义(P均<0.01),术后1个月较术后1周的BCVA有提高,差异有统计学意义(P<0.05)。术眼术前、术后1周和1个月的平均眼压分别为(16.39±3.46)mmHg(1 mmHg=0.133 kPa)、(15.37±2.32)mmHg和(16.69±2.45)mmHg,差异无统计学意义(P>0.05)。所有患眼术毕均无需缝合巩膜穿刺口。术中发生视网膜医源性裂孔1眼。随访期间发生高眼压2眼,低眼压1眼,经合理处理后眼压均恢复正常。其余患者在术中和术后随访均未见眼部或全身不良反应。结论采用27G玻璃体切除术治疗视网膜分支静脉阻塞继发的玻璃体积血是安全有效的,少有术中及术后并发症。

Clinical efficacy and safety of 27G vitrectomy for vitreous hemorrhage secondary to branch retinal vein occlusion

Objective To investigate the clinical efficacy and safety of 27G transconjunctival sutureless vitrectomy for vitreous hemorrhage secondary to branch retinal vein occlusion(BRVO).Methods The clinical data of 33 patients(33 eyes)with vitreous hemorrhage caused by BRVO who were treated with 27G vitrectomy were retrospectively analyzed.All the patients were followed up for 1 month after operation.The changes of best corrected visual acuity(BCVA)and intraocular pressure were compared before surgery,1 week and 1 month after surgery.The clinical data of vitrectomy time,incision suture and leakage,intraoperative and postoperative complications were recorded.Results The average time of vitrectomy was(16.30±4.10)minutes.The BCVAs were significantly improved 1 week and 1 month after surgery compared with those before surgery(P<0.01).The BCVA of one month after operation was higher than that of one week after operation(P<0.05).The mean IOP was(16.39±3.46)mmHg(1 mmHg=0.133 kPa),(15.37±2.32)mmHg and(16.69±2.45)mmHg before operation,1 week after operation and 1 month after operation,respectively,and there was no significant difference between them(P>0.05).There was no need to suture the wound of the scleral puncture sites in all affected eyes after operation.The complications included iatrogenic retinal breaks in 1 eye,postoperative high intraocular pressure in 2 eyes and hypotony in 1 eye during the follow-up period.After reasonable treatment,the abnormal intraocular pressure returned to normal.No ocular or systemic adverse reactions were found in the other patients during the operation and postoperative follow-up.Conclusion 27G vitrectomy is safe and effective for vitreous hemorrhage secondary to BRVO with low rates of intraoperative and postoperative complications.