Department of Ophthalmology, Calderdale NHS Foundation Trust, Salterhebble, West Yorkshire, UK.
Eye (Lond). 2010 Feb;24(2):214-20, quiz 221. doi: 10.1038/eye.2009.292. Epub 2010 Jan 15.
To evaluate the anatomical success and impact on visual acuity of 23-gauge, sutureless, phacovitrectomy, and intraocular gas tamponade for idiopathic macular hole surgery without face down posturing.
This was a non-randomised, observational, retrospective trial during the period from September 2007 to September 2008 with data collection of 40 eyes from 39 consecutive patients who underwent transconjunctival, sutureless, 23-gauge vitrectomy (TSV 23G), phacoemulsification, internal limiting membrane (ILM) peel, and intraocular gas tamponade (16% C(2)F(6)) for stage 3 and 4 idiopathic macular holes. Patients were instructed to neither posture face down nor supine post-operatively. All procedures were performed by a senior, single surgeon (RR).
The primary outcome measure was anatomical closure rate of the macular hole. Secondary outcome measure was improvement in visual acuity.
Macular holes were flat closed in 37 (92.5%) eyes at the first attempt. The remainder were eventually closed with Oxane HD tamponade without the need for face down posturing. Post-operatively, 22 out of 40 (55%) patients achieved >2 lines improvement in Snellen, visual acuity; 12 out of 40 (30%) patients achieved a 1 line improvement in Snellen, visual acuity; and 5 out of 40 (12.5%) patients' visual acuities remained stable. One patient experienced a 1 line reduction in Snellen acuity owing to co-existing ocular surface disease.
Given the well-known advantages of sutureless, vitrectomy and paucity of post-operative hypotony and endophthalmitis, we feel that the 23-gauge instrumentarium is the method of choice when combined with phacoemulsification for non-posturing, macular hole surgery.
评估 23 号无缝线经结膜、无缝线、微创玻璃体切除术（TSV23G）联合超声乳化白内障吸除术、内界膜（ILM）剥除术和眼内气体填充（16% C（2）F（6））治疗非俯卧位特发性黄斑裂孔手术的解剖成功率和对视力的影响。
这是一项非随机、观察性、回顾性试验，收集了 2007 年 9 月至 2008 年 9 月期间 39 例连续患者的 40 只眼的数据，这些患者均接受经结膜、无缝线、23 号微创玻璃体切除术（TSV23G）联合超声乳化白内障吸除术、内界膜（ILM）剥除术和眼内气体填充（16% C（2）F（6））治疗 3 期和 4 期特发性黄斑裂孔。术后指导患者既不俯卧也不仰卧。所有手术均由一位资深的、单一手术医生（RR）完成。
黄斑裂孔首次尝试时，37 只（92.5%）眼的裂孔完全封闭。其余的裂孔最终通过 Oxane HD 填充剂封闭，无需俯卧。术后，40 例中有 22 例（55%）患者的 Snellen 视力提高了>2 行；40 例中有 12 例（30%）患者的 Snellen 视力提高了 1 行；40 例中有 5 例（12.5%）患者的视力保持稳定。1 例患者由于存在眼表面疾病，视力下降了 1 行。
鉴于无缝线玻璃体切除术的显著优势，以及术后低眼压和眼内炎的发生率较低，我们认为，在不进行俯卧位手术的情况下，23 号仪器是治疗特发性黄斑裂孔的首选方法。
