Department of Ophthalmology and Visual Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
Ophthalmologica. 2011;226(4):198-204. doi: 10.1159/000330745. Epub 2011 Sep 2.
To determine the incidence of difficulty in inserting a 25- and 23-gauge trocar cannula (DITC) during 25- or 23-gauge micro-incision vitrectomy surgery (MIVS).
Retrospective, consecutive, interventional case series performed by a single surgeon at a single centre. We defined a DITC as the condition where at least 1 trocar cannula could not be inserted into the vitreous at the beginning of MIVS. The incidence of DITC was calculated from 1,525 eyes, and the pre-operative demographics of the DITC cases were compared to those of the non-DITC cases.
The incidence of DITC for all cases was 0.6% (9 of 1,525 eyes). Overall, there were 242 eyes with a retinal detachment (RD), and 8 of the 9 eyes with DITC had an RD with an incidence of 3.3% (8 of 242 RD eyes). Seven of these 8 eyes had a total RD, 4 also had a choroidal detachment, 4 eyes were also myopic (>-8.0 dpt, high myopia), and 6 of the 8 eyes were hypotonic (<8 mm Hg). The DITC cases had larger RDs (p<0.0001), a higher incidence of choroidal detachment (p<0.0001), higher myopia (p=0.0204) and hypotony (p=0.0003) than the non-DITC eyes with an RD.
A large RD, a choroidal detachment, high myopia and hypotony are significant risk factors for DITC. We recommend that MIVS should be performed cautiously for eyes with these risk factors.
确定在 25 或 23 号微切口玻璃体切除术（MIVS）中插入 25 号和 23 号套管针（DITC）的困难发生率。
由一位外科医生在一家中心进行的回顾性、连续、干预性病例系列研究。我们将 DITC 定义为至少 1 根套管针在 MIVS 开始时无法插入玻璃体的情况。从 1525 只眼中计算 DITC 的发生率，并将 DITC 病例的术前人口统计学数据与非 DITC 病例进行比较。
所有病例的 DITC 发生率为 0.6%（9/1525 只眼）。总体而言，有 242 只眼患有视网膜脱离（RD），9 只 DITC 眼中有 8 只 RD，发生率为 3.3%（242 只 RD 眼中有 8 只）。这 8 只眼中有 7 只是完全性 RD，4 只眼同时伴有脉络膜脱离，4 只眼近视（>-8.0 dpt，高度近视），6 只眼眼压降低（<8mmHg）。DITC 病例的 RD 较大（p<0.0001），脉络膜脱离发生率较高（p<0.0001），近视程度较高（p=0.0204），眼压较低（p=0.0003），与伴有 RD 的非 DITC 眼相比。
大 RD、脉络膜脱离、高度近视和低眼压是 DITC 的显著危险因素。我们建议对有这些危险因素的眼睛谨慎进行 MIVS。
