Department of Ophthalmology, Ohtsuka Eye Hospital, Sapporo, Japan.
Retina. 2012 Jun;32(6):1100-5. doi: 10.1097/IAE.0b013e3182349449.
To compare the incidence rates of retinal breaks in eyes in which posterior vitreous detachment was induced during 23-gauge and 20-gauge vitrectomies to treat macular holes or preretinal membranes.
We retrospectively reviewed 122 eyes of 115 patients with a macular hole or preretinal membrane who underwent induction of posterior vitreous detachment during 23-gauge vitrectomy (23-gauge group) and 61 eyes of 58 consecutive patients with the disorders who underwent induction of posterior vitreous detachment during 20-gauge vitrectomy performed by 1 surgeon.
No difference was found in the incidence rates of intraoperative retinal breaks between the 23-gauge (16% [20/122]) and 20-gauge (16% [10/61]) groups. A postoperative rhegmatogenous retinal detachment developed in 2 (2%) eyes in the 23-gauge group, whereas no eyes in the 20-gauge group had postoperative retinal breaks or rhegmatogenous retinal detachment. The incidence rates of retinal breaks in eyes with a macular hole and preretinal membrane did not differ significantly.
Posterior vitreous detachment induced during vitrectomy frequently results in intraoperative retinal breaks, the incidence of which may be independent of the gauge of the vitreous instruments. Surgeons should be alert to the development of retinal breaks.
比较在 23G 和 20G 玻璃体切除术中诱导玻璃体后脱离治疗黄斑裂孔或视网膜前膜时发生视网膜裂孔的发生率。
我们回顾性分析了 115 例 122 只眼的黄斑裂孔或视网膜前膜患者，这些患者均在 23G 玻璃体切除术中（23G 组）接受玻璃体后脱离诱导，以及 58 例连续患者的 61 只眼，这些患者均在同一位外科医生进行的 20G 玻璃体切除术中接受玻璃体后脱离诱导。
23G 组（16%[20/122]）和 20G 组（16%[10/61]）术中视网膜裂孔的发生率无差异。23G 组 2 只眼（2%）发生术后孔源性视网膜脱离，而 20G 组无眼发生术后视网膜裂孔或孔源性视网膜脱离。黄斑裂孔和视网膜前膜眼的视网膜裂孔发生率无显著差异。
玻璃体切除术中诱导玻璃体后脱离常导致术中视网膜裂孔，其发生率可能与玻璃体器械的规格无关。外科医生应警惕视网膜裂孔的发生。
