Wu Wei-Chi, Lai Chi-Chun, Lin Rey-In, Wang Nan-Kai, Chao An-Ning, Chen Kuan-Jen, Chen Tun-Lu, Hwang Yih-Shiou
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Arch Ophthalmol. 2011 Oct;129(10):1326-31. doi: 10.1001/archophthalmol.2011.253.
To evaluate the outcome of a novel, modified 23-gauge vitrectomy system in the treatment of stage 4 retinal detachment in retinopathy of prematurity.
Consecutive patients with stage 4 retinopathy of prematurity treated with modified 23-gauge vitrectomy were included in this medical record review. Major novel modifications included the use of a small infusion cannula, a 20-gauge blade for the creation of sclerotomies in the pars plicata, and a 23-gauge endoilluminator and vitreous cutter. Conjunctival dissection and suturing of sclerotomies were performed using this modified 3-port, 23-gauge vitrectomy technique. Anatomic success and surgical complications were analyzed.
Twenty-six eyes of 17 patients were included and analyzed. The mean (SD) gestational age was 28.0 (2.5) weeks, and the mean birth weight was 1199 (449) g. Mean postmenstrual age at the time of vitrectomy was 40.5 (3.0) weeks. Overall, 20 eyes (77%) achieved retinal attachment in a single operation, and 23 eyes (88%) achieved retinal attachment after multiple procedures. Postoperative complications included disc dragging (5 eyes [19%]), cataracts (4 [15%]), glaucoma (2 [8%]), persistent vitreous hemorrhage (1 [4%]), and posterior synechia (1 [4%]).
This 23-gauge vitrectomy system seems to be a safe and effective approach for treatment of stage 4 retinopathy of prematurity. This modified system combines the benefits of 20- and 23-gauge vitrectomy and offers safer insertion of infusion cannulas in smaller eyes, more working space in pediatric eyes, a cutting port that is closer to the retina, and a faster cutting speed with less vitreous traction during the operation.
评估一种新型改良的23G玻璃体切割系统治疗早产儿视网膜病变4期视网膜脱离的效果。
本病历回顾纳入了连续接受改良23G玻璃体切割术治疗的4期早产儿视网膜病变患者。主要的新型改良包括使用小型灌注套管、用于在锯齿缘制作巩膜切口的20G刀片、23G眼内照明器和玻璃体切割器。采用这种改良的三通道、23G玻璃体切割技术进行结膜分离和巩膜切口缝合。分析解剖学成功率和手术并发症。
纳入并分析了17例患者的26只眼。平均（标准差）胎龄为28.0（2.5）周，平均出生体重为1199（449）g。玻璃体切割术时的平均月经后年龄为40.5（3.0）周。总体而言，20只眼（77%）在单次手术中实现视网膜复位，23只眼（88%）在多次手术后实现视网膜复位。术后并发症包括视盘牵拉（5只眼[19%]）、白内障（4只眼[15%]）、青光眼（2只眼[8%]）、持续性玻璃体出血（1只眼[4%]）和虹膜后粘连（1只眼[4%]）。
这种23G玻璃体切割系统似乎是治疗4期早产儿视网膜病变的一种安全有效的方法。这种改良系统结合了20G和23G玻璃体切割术的优点，在较小的眼中提供更安全的灌注套管插入、在儿童眼中提供更多的工作空间、更靠近视网膜的切割端口以及手术期间更快的切割速度和更少的玻璃体牵拉。
