Gonzales C R, Singh S, Schwartz S D
Retina and Vitreous Center, Ashland, Oregon, USA.
Br J Ophthalmol. 2009 Jun;93(6):787-90. doi: 10.1136/bjo.2008.155655. Epub 2009 Feb 11.
This is a retrospective study of 56 eyes of 49 children undergoing vitrectomy with 25-gauge instrumentation. There were no cases of endophthalmitis, wound leaks or hypotony requiring treatment. A modified approach in which the conjunctiva and sclera is sutured was used for young babies requiring a pars plicata approach.
To evaluate the feasibility and safety of 25-gauge vitrectomy for various vitreoretinal indications in the paediatric population.
Consecutive patients aged 18 years or less undergoing vitrectomy for various vitreoretinal indications over a 5-year period were studied retrospectively. Two different surgical techniques were used: a modified 25-gauge approach in which the sclerotomies and conjunctiva were sutured as described previously for most children under the age of 1 year, and a transconjunctival 25-gauge approach for older children
56 eyes in 49 children (16 girls and 33 boys) were included. Intraoperative unplanned events or complications included: conversion to 20-gauge vitrectomy (four), conversion of one port to a 20-gauge sclerotomy (two), suspected lens damage (one) and intraoperative bleeding from a vascular ridge (one). Postoperative complications included cataract (five), rhegmatogenous retinal detachment (four) and vitreous haemorrhage (three). The four retinal detachments were either recurrent or occurred in eyes with complex ocular pathology and were not felt to be related to the surgical technique. There were no cases of postoperative hypotony requiring intervention, choroidal detachment, endophthalmitis or sclerotomy-related retinal breaks.
25-gauge vitreoretinal techniques can be used in various paediatric vitreoretinal conditions and facilitate easy access to small spaces in the paediatric eye. To avoid postoperative hypotony, a modified technique is recommended for younger babies in which the conjunctiva and sclera is sutured.
这是一项对49名儿童的56只眼睛进行25G玻璃体切割术的回顾性研究。没有发生需要治疗的眼内炎、伤口渗漏或低眼压病例。对于需要采用睫状体扁平部入路的婴儿，采用了一种改良方法，即缝合结膜和巩膜。
评估25G玻璃体切割术在儿科人群中用于各种玻璃体视网膜疾病的可行性和安全性。
回顾性研究5年内连续接受各种玻璃体视网膜疾病玻璃体切割术的18岁及以下患者。使用了两种不同的手术技术：一种改良的25G入路，如前所述，对于大多数1岁以下儿童，对巩膜切口和结膜进行缝合；另一种是针对年龄较大儿童的经结膜25G入路。
纳入49名儿童（16名女孩和33名男孩）的56只眼睛。术中意外事件或并发症包括：转为20G玻璃体切割术（4例）、将一个端口转为20G巩膜切口（2例）、疑似晶状体损伤（1例）和血管嵴术中出血（1例）。术后并发症包括白内障（5例）、孔源性视网膜脱离（4例）和玻璃体积血（3例）。这4例视网膜脱离要么是复发性的，要么发生在有复杂眼部病变的眼睛中，被认为与手术技术无关。没有需要干预的术后低眼压、脉络膜脱离、眼内炎或巩膜切口相关视网膜裂孔病例。
25G玻璃体视网膜技术可用于各种儿科玻璃体视网膜疾病，便于进入小儿眼部的狭小空间。为避免术后低眼压，建议对较小婴儿采用改良技术，即缝合结膜和巩膜。
