23G微创玻璃体切割术的临床应用

目的：探讨23G经结膜无缝合玻璃体切割系统在玻璃体视网膜疾病中的应用，观察其疗效及并发症情况。

方法：回顾性分析2011-10/2013-10在我院行23G 玻璃体切割术的患者46例48眼。其中，特发性黄斑裂孔8眼(16.7%)，特发性黄斑前膜5眼(10.4%)，玻璃体积血19眼(39.6%)，糖尿病视网膜病变V～VI期8眼(16.7%)，孔源性视网膜脱离8眼(16.7%)。观察手术前和手术后眼压变化情况、手术效果、时间、最佳矫正视力及术中、术后并发症等。术后随访1～12mo。

结果：所有病例均顺利完成手术，巩膜切口缝合组和未缝合组间术后1，7d； 1mo眼压差异均无统计学意义(均为P>0.05)； 术后最佳矫正视力均有不同程度提高，与术前比较差异均有显著统计学意义(均为P<0.01)。手术时间70.12±7.86min； 术后眼部刺激症状轻微，术后并发症少见。术中2眼套管滑脱，5眼结膜下出血，3眼结膜下气泡； 所有病例在随访期间无严重并发症发生。

结论：23G玻璃体切割术具有微创、手术时间短等优点，术后恢复快，疗效好，并发症少，将其应用于治疗玻璃体视网膜病变是一种安全有效的微创手术方法。

Clinical application of 23-gauge micro-invasive vitrectomy

AIM: To investigate the application of 23-gauge trans-conjunctival sutureless vitrectomy system in the treatment of vitreoretinopathy disease and evaluate its therapeutic effect and complications.

METHODS: This retrospective study analyzed 46 patients(48 eyes)who were performed 23-gauge vitrectomy in this hospital from October 2011 to October 2013. Among all the eyes, idiopathic macular hole 8 appeared in eyes(16.7%), idiopathic macular epiretinal membrane presented in 5 eyes(10.4%), vitreous hemorrhage appeared in 19 eyes(39.6%); PDR(stage V-VI)occurred in 8 eyes(16.7%); and RRD 8 eyes(16.7%). Observation was made on intraocular pressure before and after surgery, surgical effects, surgical time, best corrected visual acuity, intraoperative and postoperative complications. The follow-up time lasted form 1-12mo.

RESULTS:All cases were successfully performed surgery and, there was no statistical difference in intraocular pressure between the two group(P>0.05)after measuring it pre-operatively, 1, 7d and 1mo after surgery at each group. The postoperative best corrected visual acuity were improved to some different degree. The differences between postoperative and preoperative BCVA were statistically significant(P<0.01). The surgery time was 70.12±7.86min; few complications appeared after surgery. The intraoperative complications included intubation tube slippage in 2 eyes, subconjunctival hemorrhage in 5 eyes and bubble under conjunctivain in 3 eyes. No serious post-operative complication was observed during the follow-up time in all cases.

CONCLUSION: 23-gauge trans-conjunctival sutureless vitrectomy has advantages including micro-invasive cut and short surgical time. Due to its quick postoperative recovery, good curative effect and rare complication, it is an effective and safe surgical technique in the management of vitreoretinopathy disease.