Sonoda Koh-Hei, Sakamoto Taiji, Enaida Hiroshi, Miyazaki Miho, Noda Yoshihiro, Nakamura Takao, Ueno Akifumi, Yokoyama Mitsunobu, Kubota Toshiaki, Ishibashi Tatsuro
Department of Ophthalmology, Faculty of Medicine, Kyushu University Graduate School of Medical Science, Fukuoka, Japan.
Ophthalmology. 2004 Feb;111(2):226-30. doi: 10.1016/j.ophtha.2003.05.034.
To visualize the residual vitreous cortex (VC) on the retinal surface after surgical posterior vitreous separation (PVS) during a pars plana vitrectomy (PPV), especially in patients with diabetic retinopathy.
Case-control study.
Patients with proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), branch retinal vein occlusion (BRVO), and rhegmatogenous retinal detachment (RRD).
A triamcinolone acetonide (TA)-assisted vitrectomy was performed on patients with the following diseases: PDR (40 eyes), DME (26 eyes), BRVO (11 eyes), and RRD (17 eyes). Eyes with no apparent preoperative posterior vitreous detachment were enrolled in this study. After performance of surgical PVS, the residual VC was visualized as a white gel highlighted by TA. Based on this finding, the residual VC pattern was then divided into 3 groups: (1) diffuse type (VC was diffusely present in the temporal vascular arcade), (2) focal type (a small island of VC was left), and (3) no residual VC. A multivariate analysis using analysis of variance was performed regarding the residual VC pattern, disease type, age, and the 3 different surgeons.
Each surgeon determined the type of residual VC during the operation, and the results were confirmed by a postoperative review of the videotape records judged by the other 2 surgeons.
Eighty percent of the PDR eyes demonstrated the diffuse type; 10%, the focal type; and 10%, no residual VC. Fifty-eight percent of the eyes with DME demonstrated the diffuse type; 19%, the focal type; and 23%, no residual VC. Eighteen percent of the BRVO eyes showed the diffuse type; 24%, the focal type; and 59%, no residual VC. Thirty percent of the RRD eyes showed the diffuse type; 30%, the focal type; and 40%, no residual VC. A multivariate logistic regression analysis showed that PDR was a predictor of the diffuse type of residual VC in comparison to RRD (odds ratio = 8.42, 95% confidence interval = 2.07-34.3). Neither age nor the surgeon was a significant factor for a specific type of residual VC.
Diabetic eyes more often demonstrated the diffuse type of residual VC, even after surgical PVS. This information may be valuable for surgeons performing a PPV on patients with diabetic retinopathy.
在玻璃体切割术（PPV）过程中，观察手术性玻璃体后脱离（PVS）后视网膜表面的残留玻璃体皮质（VC），尤其是糖尿病视网膜病变患者的残留玻璃体皮质。
病例对照研究。
增殖性糖尿病视网膜病变（PDR）、糖尿病性黄斑水肿（DME）、视网膜分支静脉阻塞（BRVO）和孔源性视网膜脱离（RRD）患者。
对患有以下疾病的患者进行曲安奈德（TA）辅助玻璃体切除术：PDR（40只眼）、DME（26只眼）、BRVO（11只眼）和RRD（17只眼）。术前无明显玻璃体后脱离的眼纳入本研究。进行手术性PVS后，残留的VC被TA突出显示为白色凝胶。基于这一发现，将残留VC模式分为3组：（1）弥漫型（VC弥漫存在于颞侧血管弓），（2）局灶型（残留一小片VC），（3）无残留VC。对残留VC模式、疾病类型、年龄和3位不同的外科医生进行方差分析的多变量分析。
每位外科医生在手术过程中确定残留VC的类型，结果由另外2位外科医生对录像记录进行术后复查确认。
80%的PDR眼表现为弥漫型；10%为局灶型；10%无残留VC。58%的DME眼表现为弥漫型；19%为局灶型；23%无残留VC。18%的BRVO眼表现为弥漫型；24%为局灶型；
