25G微创玻璃体切除术治疗玻璃体积血的临床观察

目的：探讨25 G微创玻璃体切除术治疗玻璃体积血的临床疗效和安全性。方法：回顾性分析2012-01/2014-06经过视力、眼压、裂隙灯、眼底及B超等检查诊断为玻璃体积血患者200例208眼,所有患者采用25 G 微创玻璃体切除术。比较术前、术后1wk,1、3、6mo最佳矫正视力。观察眼压、前房炎症反应、眼底情况等临床资料。结果：术前视力光感16眼,手动82眼,指数49眼,0.01~0.09者38眼,0.1~0.2者23眼；术后6mo 视力手动1眼,指数2眼,0.01~0.09者31眼,0.1~0.2者29眼,0.2以上者145眼,术后所有患者视力稳定或不同程度提高,手术前后视力差异具有统计学意义( Z=-4.128, P=0.000)。术前平均眼压15.29±3.62mmHg,术后6mo平均眼压13.67±4.93mmHg。其中糖尿病性视网膜病变96眼(46.2％),视网膜分支静脉阻塞37眼(17.8％),视网膜中央静脉阻塞9眼(4.3％),视网膜静脉周围炎13眼(6.25％),息肉样脉络膜视网膜病13眼(6.25％),视网膜大动脉瘤5眼(2.4％),视网膜裂孔19眼(9.1％), Terson综合征16眼(7.7％)。术中联合白内障手术23眼(11.1％),术中玻璃体腔填充灌注液145眼(69.7％), C3F8气体21眼(10.1％),空气17眼(8.2％),硅油25眼(12.0％)。术后并发症：12眼(5.8％)出现术后早期一过性低眼压,8眼(3.8％)术后早期高眼压,19眼(9.1％)出现前房炎症反应,10眼(4.8％)术后早期玻璃体再出血,余所有患者在治疗过程中及治疗后随访均未见眼部或全身不良反应。结论：采用25 G微创玻璃体切除术治疗玻璃体积血是安全有效的,具有创伤小、时间短、恢复快。

Clinical study of 25G micro-incision vitrectomy on vitreous hemorrhage

AIM:To investigate the safety and effectiveness of 25G micro-incision vitrectomy on vitreous hemorrhage. METHODS:A retrospective review of 200 patients ( 208 eyes ) who were diagnosed as vitreous hemorrhage through the best - corrected visuaI acuity ( BCVA ) , intraocuIar pressure ( IOP ) , examination of sIit Iamp, examination of the ocuIar fundus and B - mode uItrasongography from January 2012 to June 2014 was taken. AII patients were treated by 25G micro-incision vitrectomy. At 1wk,1,3 and 6 mo after the surgeries, the BCVA was retrospectiveIy observed. The changes of IOP, infIammatory reaction and the ocuIar fundus were observed. RESULTS: The BCVA was Iight perception in 16 eyes, hand moving in 82 eyes,finger counting in 49 eyes, 0. 01~0. 09 in 38 eyes,0. 1 ~0. 2 in 23 eyes pre-operativeIy. At 6mo after operations, the BCVA were hand moving in 1 eyes, finger counting in 2 eyes,0. 01~0. 09 in 31 eyes, 0. 1~0. 2 in 29 eyes,>0. 2 in 145 eyes. The BCVA of aII patients kept stabIe or increased after operations and the difference before and after the operation was statisticaIIy significant (Z= -4. 128, P= 0. 000). The pre-operative mean IOP was 15. 29 ± 3. 62mmHg. The mean IOP was 13. 67±4. 93mmHg at 6mo after operations. There were 96 eyes ( 46. 2%) due to diabetic retinopathy, 37 eyes (17. 8%) due to branch retinaI vein obstruction, 9 eyes (4. 3%) due to centraI retinaI vein obstruction, 13 eyes (6. 25%) due to retinaI periphIebitis,13 eyes (6. 25%) due to poIypoidaI choroidaI vascuIopathy ( PCV ) , 5 eyes (2. 4%) due to Iarge retinaI aneurys,19 eyes (9. 1%) due to retinaI hoIe,16 eyes (7. 7%) due to Terson syndrome. PhacoemuIcification was performed for 23 eyes ( 11. 1%) during operations. There were 145 eyes ( 69. 7%) with perfusion fIuid, 21 eyes ( 10. 1%) with C3 F8 gas tamponade,17 eyes (8. 2%) with air tamponade,25 eyes (12. 0%) with siIicone oiI tamponade. There were 12 eyes (5. 8%) with transient hypotony, 8 eyes ( 3. 8%) with increased IOP, 19 eyes ( 9. 1%) with infIammation in anterior chamber, and 10 eyes ( 4. 8%) with vitreous hemorrhage after the surgery. There were no ocuIar or systemic adverse events observed in other patients. CONCLUSION:The 25G micro-incision vitrectomy is an effective and safe treatment for the patients with vitreous hemorrhage because of smaII injury, short operation time, quick recovery.