Mura Marco, Barca Francesco, Dell'Omo Roberto, Nasini Francesco, Peiretti Enrico
Department of Ophthalmology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Department of Ophthalmology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Br J Ophthalmol. 2016 Oct;100(10):1383-7. doi: 10.1136/bjophthalmol-2015-307654. Epub 2015 Dec 23.
BACKGROUND/AIMS: To evaluate the incidence of intraoperative retinal breaks in the ultrahigh-speed (UHS) 25-gauge vitrectomy system in elective vitreous-retina surgery cases.
A prospective series of 1676 eyes of 1306 consecutive patients. All eyes underwent an UHS 25-gauge transconjunctival sutureless pars plana vitrectomy for elective cases such as idiopathic epiretinal membrane (586 cases), floaters (153), macular hole (385), vitreous macular traction syndrome (119), dropped nucleus or intraocular lens (84) and vitreous bleeding (82). Patients were followed up for a minimum of 6 months.
There were 1409 eyes involved in this study. Iatrogenic retinal breaks were found in 25 eyes (1.8%) during surgery. The majority were detected in cases where posterior vitreous detachment was induced during surgery (21 eyes; 2.8% of the patients), and in only four eyes (0.6%) with an already detached vitreous. In nine cases, rhegmatogenous retinal detachment developed during the follow-up. Patients who showed intraoperative retinal breaks were not in this group. Other complications during the follow-up included two cases of vitreous haemorrhage (0.1%), two cases of dislocated intraocular lens (0.1%), and 23 eyes with hypotony without any further complications.
UHS 25-gauge transconjunctival sutureless vitrectomy is a safe procedure for treatment of elective vitreous-retina cases. The risk of developing iatrogenic breaks seems to be correlated with adhesion of the posterior vitreous hyaloid. Other complications, such as rhegmatogenous retinal detachment or hypotony, were similar to previous reports. No correlation was found between iatrogenic retina breaks and other complications.
背景/目的：评估在择期玻璃体视网膜手术中，超高速（UHS）25G玻璃体切割系统导致术中视网膜裂孔的发生率。
对1306例连续患者的1676只眼进行前瞻性研究。所有眼睛均接受UHS 25G经结膜无缝合扁平部玻璃体切除术，用于治疗特发性视网膜前膜（586例）、飞蚊症（153例）、黄斑裂孔（385例）、玻璃体黄斑牵引综合征（119例）、晶状体或人工晶状体脱位（84例）以及玻璃体积血（82例）等择期病例。患者至少随访6个月。
本研究共纳入1409只眼。术中发现25只眼（1.8%）出现医源性视网膜裂孔。大多数裂孔出现在手术中诱发玻璃体后脱离的病例中（21只眼；占患者的2.8%），而在玻璃体已脱离的患者中仅4只眼（0.6%）出现裂孔。随访期间有9例发生孔源性视网膜脱离。出现术中视网膜裂孔的患者不在该组。随访期间的其他并发症包括2例玻璃体积血（0.1%）、2例人工晶状体脱位（0.1%）以及23只眼出现低眼压且无其他进一步并发症。
UHS 25G经结膜无缝合玻璃体切除术是治疗择期玻璃体视网膜疾病的安全手术。医源性裂孔的发生风险似乎与玻璃体后皮质的粘连有关。其他并发症，如孔源性视网膜脱离或低眼压，与既往报道相似。未发现医源性视网膜裂孔与其他并发症之间存在相关性。
