Tosi Gian Marco, Malandrini Alex, Cevenini Gabriele, Neri Giovanni, Marigliani Davide, Cerruto Arianna, Virgili Gianni
*Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; †Ophthalmology Unit, Santo Stefano Hospital, Prato, Italy; ‡Department of Medical Biotechnologies, University of Siena, Siena, Italy; and §Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Retina. 2017 Oct;37(10):1948-1955. doi: 10.1097/IAE.0000000000001445.
To study the patterns of vitreous incarceration at sclerotomy sites by ultrasound biomicroscopy in patients subjected to valved or nonvalved small-gauge pars plana vitrectomy.
A prospective comparative study of 88 eyes affected by epiretinal membrane and macular hole. Patients were divided into four groups: valved or nonvalved 23-gauge (16 eyes each) and valved or nonvalved 25-gauge (20 eyes each); their vitreal disposition was compared by ultrasound biomicroscopy. Vitreal disposition was also assessed in 16 eyes of 16 patients subjected to valved 27-gauge pars plana vitrectomy.
Three vitreal patterns were identified: P0 (vitreous not visible or vitreous strand distant from the sclerotomy site), P1 (vitreous strand parallel to and in contact with the sclerotomy site), and P2 (vitreous strand entrapped in the sclerotomy site). The effect of valved trocar use on vitreous incarceration seemed to be somewhat beneficial, but no statistically significant effect could be shown (odds ratio: 0.85, 95% confidence interval: 0.42-1.74, P = 0.657). Similarly, no differences in vitreous incarceration were shown among vitrectomy gauges (23, 25, or 27) both in a model including valved trocars only (P = 0.858) and in a model with all available data (P = 0.935).
In 23- and 25-gauge macular surgeries, postoperative vitreous incarceration does not seem to be reduced using valved cannulas and was similar to that observed in 27-gauge surgery.
通过超声生物显微镜检查研究接受带瓣或不带瓣小切口玻璃体切割术患者巩膜切口处玻璃体嵌顿的模式。
对88只患有视网膜前膜和黄斑裂孔的眼睛进行前瞻性对照研究。患者被分为四组：带瓣或不带瓣23G（每组16只眼）和带瓣或不带瓣25G（每组20只眼）；通过超声生物显微镜检查比较它们的玻璃体情况。还对16例接受带瓣27G玻璃体切割术患者的16只眼的玻璃体情况进行了评估。
确定了三种玻璃体模式：P0（玻璃体不可见或玻璃体条索远离巩膜切口处）、P1（玻璃体条索与巩膜切口处平行且接触）和P2（玻璃体条索嵌顿在巩膜切口处）。使用带瓣套管对玻璃体嵌顿的影响似乎有些益处，但未显示出统计学上的显著效果（优势比：0.85，95%置信区间：0.42 - 1.74，P = 0.657）。同样，在仅包括带瓣套管的模型（P = 0.858）和包含所有可用数据的模型（P = 0.935）中，玻璃体切割术的不同规格（23G、25G或27G）之间在玻璃体嵌顿方面均未显示出差异。
在23G和25G黄斑手术中，使用带瓣套管似乎并未减少术后玻璃体嵌顿，且与27G手术中观察到的情况相似。
