Mid Atlantic Retina, Retina Service of Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Retina. 2012 Nov-Dec;32(10):2119-26. doi: 10.1097/IAE.0b013e31825a89c3.
To assess the utility of the torsional phacoemulsification handpiece compared to the Fragmatome during pars plana vitrectomy for removal of posterior segment retained lens material.
: Retrospective comparative case series.
Thirty-four eyes of 34 patients at 2 centers who underwent pars plana vitrectomy for retained lens material with either torsional phacoemulsification or the Fragmatome were retrospectively reviewed. Lens material was graded by nuclear density and percentage of total nuclear size. The primary outcome measure was mean change in visual acuity. Secondary outcomes included intraoperative or postoperative complications, occurrence of mechanical malfunctions and metric data including the total ultrasound, phacoemulsification, and torsional times.
In the torsional ultrasound group (17 eyes), mean nuclear density was 3.6 and mean size was 63%. Mean initial logarithm of minimum angle of resolution visual acuity was 1.58 (20/760) and improved to 0.66 (20/80) at postoperative Month 3, a gain of 0.92 (P = 0.003). One eye developed a self-limited, peripheral, serous, choroidal detachment intraoperatively, whereas two eyes developed postoperative cystoid macular edema. Mean total ultrasound, phacoemulsification, and torsional times were 76.7, 13.4, and 63.3 seconds, respectively. Mean total operative time to remove retained lens material (excluding vitreous gel removal) was 111 seconds. All the patients demonstrated excellent followability based on independent observations by the surgeons. In the Fragmatome group (17 eyes), initial logarithm of minimum angle of resolution visual acuity was 1.51 (20/640) and improved to 0.6 (20/80) at postoperative Month 3, a gain of 0.91 (P < 0.001). One eye developed a retinal detachment at postoperative Week 2, whereas 3 eyes developed postoperative cystoid macular edema.
The use of torsional phacoemulsification during pars plana vitrectomy for retained lens material is a novel approach with potential advantages over the standard 20-gauge Fragmatome, including improved followability and purchase of lens material attributable to the addition of torsional movement.
评估与 Fragmatome 相比，扭力超声乳化手柄在经睫状体平坦部玻璃体切割术（PPV）中用于切除后段残留晶状体物质的效果。
回顾性对比病例系列研究。
对在 2 个中心接受 PPV 以切除残留晶状体物质的 34 只眼（34 例患者）进行回顾性分析，这些眼分别使用扭力超声乳化或 Fragmatome。晶状体物质按核密度和总核大小的百分比分级。主要观察指标为视力的平均变化。次要观察指标包括术中或术后并发症、机械故障的发生以及总超声时间、超声乳化时间和扭力时间等计量数据。
在扭力超声组（17 只眼）中，平均核密度为 3.6，平均核大小为 63%。平均初始最小分辨角视力对数为 1.58（20/760），术后 3 个月提高至 0.66（20/80），提高了 0.92（P=0.003）。1 只眼术中出现自限性周边浆液性脉络膜脱离，2 只眼术后出现囊样黄斑水肿。总超声时间、超声乳化时间和扭力时间分别为 76.7、13.4 和 63.3 秒。去除残留晶状体物质（不包括玻璃体凝胶去除）的总手术时间为 111 秒。所有患者的随访情况均良好，基于手术医生的独立观察。在 Fragmatome 组（17 只眼）中，初始最小分辨角视力对数为 1.51（20/640），术后 3 个月提高至 0.6（20/80），提高了 0.91（P<0.001）。1 只眼术后 2 周发生视网膜脱离，3 只眼术后发生囊样黄斑水肿。
在经睫状体平坦部玻璃体切割术（PPV）中使用扭力超声乳化术切除残留晶状体物质是一种新方法，与标准 20-gauge Fragmatome 相比具有潜在优势，包括改善的随访能力和由于添加了扭力运动而增加的晶状体物质获取能力。
