Oshima Yusuke, Ohji Masahito, Tano Yasuo
Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
Ann Acad Med Singap. 2006 Mar;35(3):175-80.
To report surgical outcomes of 25-gauge transconjunctival vitrectomy combined with cataract surgery for the management of a variety of vitreoretinal diseases.
A retrospective, interventional case study was conducted. Chart review of a consecutive series of 150 eyes of 144 patients who underwent 25-gauge vitrectomy combined with phacoemulsification and intraocular lens implantation for epiretinal membrane (n = 62), refractory macular oedema associated with retinal vascular disorders (n = 29), idiopathic macular hole (n = 21), non-clearing vitreous haemorrhage (n = 18), rhegmatogenous retinal detachment (n = 11), tractional retinal detachment associated with proliferative diabetic retinopathy (n = 7), and subretinal haemorrhage (n = 2). Main outcome measures included preand postoperative visual acuity, operating time, intraocular pressure, intra- and postoperative complications.
The mean follow-up period was 9.7 months (range, 6 to 26). The mean overall visual acuity improved from 20/100 preoperatively to 20/38 at final visit (P <0.001). Statistically significant improvement of visual acuity was also observed in each subgroup. Operative time was shortened in macular surgery. No intraoperative complications were noted attributable to small-gauge instruments and no cases required conversion to 20-gauge standard instrumentation. However, 12 eyes (8%) required suture placement to at least one sclerotomy site. Postoperative intraocular pressure remained stable in most cases except 18 eyes (13%) with transient hypotony during the first week after surgery. One case of retinal detachment but no case of endophthalmitis was observed throughout the follow-up period.
25-gauge vitrectomy combined with cataract surgery is a safe and effective system for the management of a variety of vitreoretinal diseases, especially cases requiring minimal intraocular manipulation. Further study is recommended to evaluate potential postoperative complications.
报告25G经结膜玻璃体切除术联合白内障手术治疗多种玻璃体视网膜疾病的手术效果。
进行一项回顾性干预性病例研究。对144例患者的连续150只眼的病历进行回顾，这些患者接受了25G玻璃体切除术联合超声乳化白内障吸除术及人工晶状体植入术，其中视网膜前膜62例，与视网膜血管疾病相关的难治性黄斑水肿29例，特发性黄斑裂孔21例，非清除性玻璃体积血18例，孔源性视网膜脱离11例，增殖性糖尿病视网膜病变相关的牵拉性视网膜脱离7例，视网膜下出血2例。主要观察指标包括术前和术后视力、手术时间、眼压、术中及术后并发症。
平均随访时间为9.7个月（范围6至26个月）。平均总体视力从术前的20/100提高到末次随访时的20/38（P<0.001）。各亚组的视力也有统计学意义的显著改善。黄斑手术的手术时间缩短。未发现因小口径器械导致的术中并发症，也无病例需要转换为20G标准器械。然而，12只眼（8%）至少有一个巩膜切口部位需要缝合。除18只眼（13%）在术后第一周出现短暂低眼压外，大多数病例术后眼压保持稳定。随访期间观察到1例视网膜脱离，但未观察到眼内炎病例。
25G玻璃体切除术联合白内障手术是治疗多种玻璃体视网膜疾病的一种安全有效的方法，尤其是对需要最小限度眼内操作的病例。建议进一步研究以评估潜在的术后并发症。
